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Understanding HIV ‘Treatment Cascade’ Critical For Program Success

In a joint post in the Center for Global Development’s (CGD) “Global Health Policy” blog, senior fellow Mead Over and research assistant Yuna Sakuma examine the issue of retention with respect to HIV treatment, which they note was discussed at the October 2 PEPFAR Scientific Advisory Board meeting. “For years even the friendliest critics of the global struggle against AIDS have pointed out that [simply counting the number of patients on treatment] unfairly neglects the people who are not put on treatment and then die, largely because their deaths are uncounted except in so far as they increase the treatment ‘coverage rate,’” they write, examining the so-called “treatment cascade” and some of the data presented at the meeting.  They continue, “Even if a proper measure of retention in treatment yields a less pessimistic estimate of the attrition in the treatment cascade, the enormous loss of patients throughout the treatment cascade remains a glaring reminder of the need to better understand the causes of patient loss at every stage in the cascade and how these losses can be stemmed” (10/29).