title: The HIV care continuum in Latin America: challenges and opportunities.
abstract: Combination antiretroviral therapy (ART), also known as highly active antiretroviral therapy, provides clinical and immunological benefits for people living with HIV and is an effective strategy to prevent HIV transmission at the individual level. Early initiation of ART as part of a test and treat approach might decrease HIV transmission at the population level, but to do so the HIV continuum of care, from diagnosis to viral suppression, should be optimised. Access to ART has improved greatly in Latin America, and about 600,000 people are on treatment. However, health-care systems are deficient in different stages of the HIV continuum of care, and in some cases only a small proportion of individuals achieve the desired outcome of virological suppression. At present, data for most Latin American countries are not sufficient to build reliable metrics. Available data and estimates show that many people living with HIV in Latin America are unaware of their status, are diagnosed late, and enter into care late. Stigma, administrative barriers, and economic limitations seem to be important determinants of late diagnosis and failure to be linked to and retained in care. Policy makers need reliable data to optimise the HIV care continuum and improve individual-based and population-based outcomes of ART in Latin America.
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, GA, USA; Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran', Tlalpan, Mexico.
authors.forename: Alicia
authors.initials: A
authors.lastname: Piñeirúa
authors.affiliation: Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran', Tlalpan, Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Sierra-Madero
authors.affiliation: Juan A Fernandez Hospital, Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.affiliation: Department of Infectious Diseases, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Rafael Napoleón
authors.initials: RN
authors.lastname: Guevara Palmero
authors.affiliation: Infectious Diseases, Department of Internal Medicine, Universidad del Valle, Santiago de Cali, Colombia.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Martínez Buitrago
authors.affiliation: International Association of Providers of AIDS Care, Washington, DC, USA; Josef Korbel School of International Studies, University of Denver, Denver, CO, USA. Electronic address: byoung@iapac.org.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Young
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, GA, USA; Emory University Center for AIDS Research, Atlanta, GA, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care; D042241:Early Diagnosis; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D015995:Prevalence; D019562:Viral Load