HIV Care Cascade

Antiretrovirals for treatment of HIV are becoming increasingly available in sub-Saharan Africa, as we now understand that these drugs enable infected individuals to attain near natural life expectancy when administered optimally. To achieve such successful outcomes patients must pass through the ‘HIV care cascade’ via an ideal route. The optimum pathway includes early HIV testing, linkage to care, timely ART initiation and subsequent monitoring to assess adherence and ensure treatment continuation.


Clinical service provision data indicate that there are deficits in engagement with all stages of care, to varying degrees, for many individuals attending clinics in sub-Saharan Africa. Identifying which barriers to care are most common or have the greatest impact on patient health is crucial to reviewing and improving effectiveness of current programmes. The Bill and Melinda Gates Foundation highlighted the need to identify key areas of improvement in the care cascade to the HIV Modelling Steering Committee and a modelling exercise was devised which aims to isolate particular areas of the care system which are failing patients and causing increased morbidity and mortality.


Aim: To better understand how individuals pass through the HIV Care Cascade and how this pathway might be modified to maximise the impact of ART and generate optimal health benefits for HIV+ve individuals.

The Modelling Consortium Secretariat is working to answer this question within the internal modelling team. An individual-based model describing the experience of a cohort of HIV+ve adults proceeding through the HIV care system, including diagnosis, pre-ART care and monitoring, followed by ART care. The model is calibrated to represent the current functioning of a typical HIV care program in sub-Saharan Africa, reflecting a realistic pattern of HIV disease progression, incidence of AIDS-defining illness and survival.

The Modelling Consortium hope to work with the AMPATH Partnership to calibrate this model to data for clinics in Kenya to better understand how individual centres can optimize patient outcomes.


  1. Timothy B Hallett, Jeffrey W Eaton. A Side-door into Care Cascade for HIV-Infected Patients? J Acquir Immune Defic Syndr. 2013 Jul;63 Suppl 2:S228-32.