title: Diagnosis and monitoring of HIV programmes to support treatment initiation and follow up and improve programme quality.
abstract: The HIV 'cascade of care' breaks down at several points, with delayed HIV diagnosis, late treatment initiation, or interruption, leading to new morbidity and mortality and loss of prevention effects. New approaches are needed at each step.
  
  
  
  HIV testing is still not reaching certain communities, resulting in late presentation. Creative ways to reach these communities is being explored, including with self-testing. HIV misdiagnosis is increasingly recognized as undermining testing programmes, highlighting the need for better quality control. More rapid antiretroviral initiation, even on the same day, initiation outside of health facilities, and more efficient defaulter re-initiation, may mean better retention and virological control. New antiretrovirals may address side effects responsible for poor adherence and treatment failure, as well as requiring lower adherence levels. Viral load monitoring expansion is required, but mechanisms are needed to ensure healthcare workers act on detectable results; point of care technologies may partly address this. Side-effect monitoring at a programme level is needed to characterise 'real world' effectiveness.
  
  
  
  Integrated monitoring systems, using single patient identifiers and utilizing national laboratory data systems, will allow for better characterization and interventions that limit loss to follow up, and allow better pharmacovigilance and programme performance.
authors.affiliation: aReproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa bHIV/AIDS Department, World Health Organization, Geneva, Switzerland cDepartment of Molecular Medicine and Haematology, University of the Witwatersrand dNational Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Willem Daniel Francois
authors.initials: WD
authors.lastname: Venter
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Marco
authors.initials: M
authors.lastname: Vitoria
authors.forename: Wendy
authors.initials: W
authors.lastname: Stevens
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data*; D019468:Disease Management; D016903:Drug Monitoring / Q000379:methods / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D011787:Quality of Health Care; D055502:Secondary Prevention
chemical_list: D019380:Anti-HIV Agents