title: A Framework for Health Communication Across the HIV Treatment Continuum.
abstract: As test and treat rolls out, effective interventions are needed to address the determinants of outcomes across the HIV treatment continuum and ensure that people infected with HIV are promptly tested, initiate treatment early, adhere to treatment, and are virally suppressed. Communication approaches offer viable options for promoting relevant behaviors across the continuum.
  
  
  
  This article introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low- and medium-income countries. The framework includes HIV testing and counseling, linkage to care, retention in pre-antiretroviral therapy and antiretroviral therapy initiation in one single-stage linkage to care and treatment, and adherence for viral suppression. The determinants of behaviors vary across the continuum and include both facilitators and barriers with communication interventions designed to focus on specific determinants presented in the model. At each stage, relevant determinants occur at the various levels of the social-ecological model: intrapersonal, interpersonal, health services, community, and policy. Effective health communication interventions have mainly relied on mHealth, interpersonal communication through service providers and peers, community support groups, and treatment supporters.
  
  
  
  The conceptual framework and evidence presented highlight areas across the continuum where health communication can significantly impact treatment outcomes to reach the 90-90-90 goals by strategically addressing key behavioral determinants. As test and treat rolls out, multifaceted health communication approaches will be critical.
authors.affiliation: *Johns Hopkins Center for Communication Programs, Baltimore, MD; and †United States Agency for International Development, Washington, DC.
authors.forename: Stella
authors.initials: S
authors.lastname: Babalola
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Van Lith
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Mallalieu
authors.forename: Zoe R
authors.initials: ZR
authors.lastname: Packman
authors.forename: Emily
authors.initials: E
authors.lastname: Myers
authors.forename: Kim Seifert
authors.initials: KS
authors.lastname: Ahanda
authors.forename: Emily
authors.initials: E
authors.lastname: Harris
authors.forename: Tilly
authors.initials: T
authors.lastname: Gurman
authors.forename: Maria-Elena
authors.initials: ME
authors.lastname: Figueroa
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003266:Continuity of Patient Care; D003376:Counseling; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D015438:Health Behavior; D058015:Health Communication; D006801:Humans; D010342:Patient Acceptance of Health Care
chemical_list: D044966:Anti-Retroviral Agents