title: The utility of population-based surveys to describe the continuum of HIV services for key and general populations.
abstract: Monitoring the cascade or continuum of HIV services - ranging from outreach services to anti-retroviral treatment - has become increasingly important as the focus in prevention moves toward biomedical interventions, in particular, 'Treatment as Prevention.' The HIV continuum typically utilises clinic-based care and treatment monitoring data and helps identify gaps and inform programme improvements. This paper discusses the merits of a population-based survey-informed continuum of services. Surveys provide individual-level, population-based data by sampling persons both in and outside the continuum, which facilitate the estimation of population fractions, such as the proportion of people living with HIV in care, as well as the examination of determinants for being in or outside the continuum. Survey-informed cascades of services may especially benefit key populations at increased risk for HIV infection for who social marginalisation, criminalisation, and stigma result in barriers to access and retention in services, a low social visibility, mobility, and outreach-based services can compromise clinic-based monitoring. Adding CD4+ T-cell count and viral load measurements to such surveys may provide population-level information on viral load suppression, stage of disease, treatment needs, and population-level transmission potential. While routine clinic-based reporting will remain the mainstay of monitoring, a survey-informed service cascade can address some of its limitations and offer additional insights.
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA wfh3@cdc.gov.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hladik
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Benech
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Moses
authors.initials: M
authors.lastname: Bateganya
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Avi J
authors.initials: AJ
authors.lastname: Hakim
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D003266:Continuity of Patient Care; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D011795:Surveys and Questionnaires; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; Continuum of HIV services; HIV; antiretroviral therapy; care and treatment; cascade of services; key populations; population-based surveys; treatment