title: Monitoring HIV Treatment and the Health Sector Cascade: From Treatment Numbers to Impact.
abstract: Although not originally part of the MDGs, HIV treatment has been at the center of global HIV reporting since 2003, marked by achievement of the target of 15 million people receiving treatment before 2015 and 18.2 million (16.1-19.0 million) by mid 2016. Monitoring of treatment has been strengthened with harmonized partner reporting and accountability with regular, annual reports. Beyond treatment numbers, increasingly measures of treatment adherence, retention and outcomes have been reported though with varying quality and completeness. However, with the sustainable development goals (SDGs), monitoring treatment is changing in three important ways. First, treatment monitoring is shifting from numbers to coverage and gaps in a cascade of services to achieve universal access. Secondly, this requires greater emphasis on disaggregated, individual level patient and case monitoring systems, which can better support linkage, retention and chronic, long term care. Thirdly, the prevention, testing and treatment cascade with a clear results chain, links treatment numbers to impact, in terms of reduced viral load, mortality and incidence. This agenda will require a greater contribution of routine impact evaluation alongside monitoring, with treatment seen as part of a cascade of services to ensure impact on mortality and incidence. In conclusion, the shift from monitoring treatment numbers to treatment linked to universal access to prevention, testing and treatment and impact on mortality and incidence, will be critical to monitor, evaluate, and improve HIV programs as part of the SDGs.
authors.affiliation: HIV Department, WHO, Geneva, Switzerland. LowBeerd@who.int.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0003-0042-0518
authors.initials: D
authors.lastname: Low-Beer
authors.affiliation: HIV Department, WHO, Geneva, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Beusenberg
authors.affiliation: HIV Department, WHO, Geneva, Switzerland.
authors.forename: Chika
authors.initials: C
authors.lastname: Hayashi
authors.affiliation: HIV Department, WHO, Geneva, Switzerland.
authors.forename: Txema
authors.initials: T
authors.lastname: Calleja
authors.affiliation: UNAIDS, Geneva, Switzerland.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Marsh
authors.affiliation: HIV Department, WHO, Geneva, Switzerland.
authors.forename: Awandha
authors.initials: A
authors.lastname: Mamahit
authors.affiliation: HIV Department, WHO, Geneva, Switzerland.
authors.forename: Theresa
authors.initials: T
authors.lastname: Babovic
authors.affiliation: HIV Department, WHO, Geneva, Switzerland.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Hirnschall
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003140:Communicable Disease Control / Q000379:methods / Q000458:organization & administration*; D006078:Government Programs; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D009313:National Health Programs / Q000458:organization & administration*; D011159:Population Surveillance / Q000379:methods*; D015397:Program Evaluation; D011634:Public Health; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; Health sector cascade; Impact; Program improvement; Sustainable development goals; Treatment