Review article: Biomedical intelligence
Vol. 151 No. 2728 (2021)
“Linkage to care” among people living with HIV – definition in the era of “universal test and treat” in a sub-Sahara African setting
Prompt linkage to human immunodeficiency virus (HIV) care after diagnosis is of utmost importance for individual health and reduction of HIV transmission. Different definitions for “linkage to care” have challenged comparisons as a public health marker. Its meaning in the era of “universal test and treat” has transformed in all settings, but is most relevant in sub-Sahara Africa, where the burden of new HIV infection is still highest.
For this narrative review on “linkage to care” definitions with a focus on sub-Saharan Africa, we searched PubMed/Medline between September and December 2020, restricted to the period 2000–2020 using Boolean operators: “HIV” AND (“linkage to care” OR “engagement in care”) and screened for institutional definitions of “linkage to care”. Additionally, as one example of a rural sub-Saharan African setting, we analysed linkage steps within the Chronic Diseases Clinic Ifakara (CDCI) and its associated Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) in rural Tanzania between 1 January 2017 and 31 March 2019.
We analysed 81 articles that included “linkage to care” within different study settings and HIV organisations. Major differences in defining “linkage to care” exist, according to setting and location, patient populations and the timing of steps within the linkage process. We identified 16 different numerators and 10 denominators used to define linkage with time periods ranging from “same day as diagnosis” up to 12 months after diagnosis among 34 original articles from sub-Saharan Africa. At the CDCI, 1149/1671 (69%) newly diagnosed individuals were enrolled into care after diagnosis. Three months after enrolment into care, 94%, 86%, 85% and 71% of enrolled patients had a laboratory evaluation, a clinical evaluation, were initiated on treatment and had a first clinical follow-up visit after initiation of treatment, respectively.
To address the inconsistency in defining “linkage to care” and in order to guarantee the comparability of “linkage to care” in the sub-Saharan Africa region, we support the definition from the European region with some adaptions. We suggest a priority list of care indicators if more than one care indicator is available for successful “linkage to care” in the era of “universal test and treat” for sub-Sahara Africa.
- Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800. doi:.https://doi.org/10.1093/cid/ciq243
- Kranzer K, Govindasamy D, Ford N, Johnston V, Lawn SD. Quantifying and addressing losses along the continuum of care for people living with HIV infection in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2012;15(2):17383. doi:.https://doi.org/10.7448/IAS.15.2.17383
- Barnabas RV, Celum C. Closing the gaps in the HIV care continuum. PLoS Med. 2017;14(11):e1002443. doi:.https://doi.org/10.1371/journal.pmed.1002443
- Church K, Machiyama K, Todd J, Njamwea B, Mwangome M, Hosegood V, et al. Identifying gaps in HIV service delivery across the diagnosis-to-treatment cascade: findings from health facility surveys in six sub-Saharan countries. J Int AIDS Soc. 2017;20(1):21188. doi:.https://doi.org/10.7448/IAS.20.1.21188
- Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007-2009: systematic review. Trop Med Int Health. 2010;15(Suppl 1):1–15. doi:.https://doi.org/10.1111/j.1365-3156.2010.02508.x
- Haber N, Tanser F, Bor J, Naidu K, Mutevedzi T, Herbst K, et al. From HIV infection to therapeutic response: a population-based longitudinal HIV cascade-of-care study in KwaZulu-Natal, South Africa. Lancet HIV. 2017;4(5):e223–30. doi:.https://doi.org/10.1016/S2352-3018(16)30224-7
- Dombrowski J. National HIV Curriculum: Linkage to care. Available from: https://cdn.hiv.uw.edu/pdf/screening-diagnosis/linkage-care/core-concept/all [accessed 2020 October 19].
- Fox MP, Rosen S. A new cascade of HIV care for the era of “treat all”. PLoS Med. 2017;14(4):e1002268. doi:.https://doi.org/10.1371/journal.pmed.1002268
- Croxford S, Raben D, Jakobsen SF, Burns F, Copas A, Brown AE, et al.; On Behalf Of OptTEST By Hiv In Europe. Defining linkage to care following human immunodeficiency virus (HIV) diagnosis for public health monitoring in Europe. Euro Surveill. 2018;23(48). doi:.https://doi.org/10.2807/1560-7917.ES.2018.23.48.1700858
- Mugglin C, Kläger D, Gueler A, Vanobberghen F, Rice B, Egger M, et al. The HIV Care Cascade in sub-Saharan Africa: Systematic Review of Published Criteria and Definitions 2021.Open Science Framework. Available from: https://osf.io/w6qjv [accessed 2021 April 14].
- Vanobberghen F, Letang E, Gamell A, Mnzava DK, Faini D, Luwanda LB, et al.; KIULARCO Study Group. A decade of HIV care in rural Tanzania: Trends in clinical outcomes and impact of clinic optimisation in an open, prospective cohort. PLoS One. 2017;12(7):e0180983. doi:.https://doi.org/10.1371/journal.pone.0180983
- Letang E, Kalinjuma AV, Glass TR, Gamell A, Mapesi H, Sikalengo GR, et al.; Kiularco Study Group. Cohort profile: The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) - A prospective HIV cohort in rural Tanzania. Swiss Med Wkly. 2017;147:w14485. doi:.https://doi.org/10.4414/smw.2017.14485
- World Health Organization. Patient monitoring guidelines for HIV care and antiretroviral therapy. Geneva: WHO; 2006. Available at: https://www.who.int/3by5/capacity/ptmonguidelinesfinalv1.PDF?ua=1 [accessed: 2020 November 21].
- Cheever LW. Engaging HIV-infected patients in care: their lives depend on it. Clin Infect Dis. 2007;44(11):1500–2. doi:.https://doi.org/10.1086/517534
- Mugavero MJ, Norton WE, Saag MS. Health care system and policy factors influencing engagement in HIV medical care: piecing together the fragments of a fractured health care delivery system. Clin Infect Dis. 2011;52(Suppl 2):S238–46. doi:.https://doi.org/10.1093/cid/ciq048
- Kay ES, Batey DS, Mugavero MJ. The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther. 2016;13(1):35. doi:.https://doi.org/10.1186/s12981-016-0120-0
- Gueler A, Vanobberghen F, Rice B, Egger M, Mugglin C. The HIV Care Cascade from HIV diagnosis to viral suppression in sub-Saharan Africa: a systematic review and meta-regression analysis protocol. Syst Rev. 2017;6(1):172. doi:.https://doi.org/10.1186/s13643-017-0562-z
- Drew RS, Rice B, Rüütel K, Delpech V, Attawell KA, Hales DK, et al. HIV continuum of care in Europe and Central Asia. HIV Med. 2017;18(7):490–9. doi:.https://doi.org/10.1111/hiv.12480
- Joint United Nations Programme on HIV/AIDS (UNAIDS). 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.
- Office of National AIDS Policy. National HIV/AIDS strategy: improving outcomes: accelerating progress along the HIV care continuum; 2013. Available at: https://obamawhitehouse.archives.gov/sites/default/files/onap_nhas_improving_outcomes_dec_2013.pdf [accessed: 2020 October 27].
- White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States: Updated to 2020. Washington, DC. July 2015. Available at: https://www.hiv.gov/sites/default/files/nhas-2020-action-plan.pdf [accessed: 2020 October 21].
- World Health Organization (WHO). Consolidated strategic information guidelines for HIV in the health care sector. Geneva; WHO; 2015; Available from: https://www.who.int/hiv/pub/guidelines/strategic-information-guidelines/en/ [accessed: 2020 October 21].
- Granich R, Gupta S, Hall I, Aberle-Grasse J, Hader S, Mermin J. Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review. PLoS Med. 2017;14(4):e1002253. doi:.https://doi.org/10.1371/journal.pmed.1002253
- Medland NA, McMahon JH, Chow EP, Elliott JH, Hoy JF, Fairley CK. The HIV care cascade: a systematic review of data sources, methodology and comparability. J Int AIDS Soc. 2015;18(1):20634. doi:.https://doi.org/10.7448/IAS.18.1.20634
- Joint United Nations Programme on HIV/AIDS (UNAIDS). 95-95-95 targets for 2025. Available at: https://aidstargets2025.unaids.org [accessed 2021 March 21].
- Joint United Nations Programme on HIV/AIDS (UNAIDS). Prevailing against pandemics by putting people at the center - World AIDS day report 2020. Available at: https://www.unaids.org/en/resources/documents/2020/prevailing-against-pandemics [accessed: 2021 February 07].
- Labhardt ND, Ringera I, Lejone TI, Klimkait T, Muhairwe J, Amstutz A, et al. Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho: The CASCADE Randomized Clinical Trial. JAMA. 2018;319(11):1103–12. doi:.https://doi.org/10.1001/jama.2018.1818
- Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, et al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet Public Health. 2017;2(1):e35–46. doi:.https://doi.org/10.1016/S2468-2667(16)30020-2
- Dombrowski J. National HIV Curriculum: Linkage to care. Available from: https://www.hiv.uw.edu/go/screening-diagnosis/linkage-care/core-concept/all [accessed: 2020 January 14].
- Coffey S, Bacchetti P, Sachdev D, Bacon O, Jones D, Ospina-Norvell C, et al. RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population. AIDS. 2019;33(5):825–32. doi:.https://doi.org/10.1097/QAD.0000000000002124
- Robertson M, Laraque F, Mavronicolas H, Braunstein S, Torian L. Linkage and retention in care and the time to HIV viral suppression and viral rebound - New York City. AIDS Care. 2015;27(2):260–7. doi:.https://doi.org/10.1080/09540121.2014.959463
- Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al., INSIGHT START Study Group. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015;373(9):795–807. doi:.https://doi.org/10.1056/NEJMoa1506816
- Danel C, Moh R, Gabillard D, Badje A, Le Carrou J, Ouassa T, et al., TEMPRANO ANRS 12136 Study Group. A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa. N Engl J Med. 2015;373(9):808–22. doi:.https://doi.org/10.1056/NEJMoa1507198
- Herce ME, Chi BH, Liao RC, Hoffmann CJ. Re-thinking Linkage to Care in the Era of Universal Test and Treat: Insights from Implementation and Behavioral Science for Achieving the Second 90. AIDS Behav. 2019;23(S2, Suppl 2):120–8. doi:.https://doi.org/10.1007/s10461-019-02541-5
- Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV. WHO Guidelines Approved by the Guidelines Review Committee. Geneva2015.
- Centers for Disease Control and Prevention. Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data United States and 6 Dependent Areas, 2018 HIV Surveillance Supplemental Report. 2020;25(No. 2):1–104. Published May 2020. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-25-2.pdf [accessed 2020 October 20]
- Iwuji CC, Orne-Gliemann J, Larmarange J, Okesola N, Tanser F, Thiebaut R, et al.; ANRS 12249 TasP trial group. Uptake of Home-Based HIV Testing, Linkage to Care, and Community Attitudes about ART in Rural KwaZulu-Natal, South Africa: Descriptive Results from the First Phase of the ANRS 12249 TasP Cluster-Randomised Trial. PLoS Med. 2016;13(8):e1002107. doi:.https://doi.org/10.1371/journal.pmed.1002107
- Barnabas RV, van Rooyen H, Tumwesigye E, Murnane PM, Baeten JM, Humphries H, et al. Initiation of antiretroviral therapy and viral suppression after home HIV testing and counselling in KwaZulu-Natal, South Africa, and Mbarara district, Uganda: a prospective, observational intervention study. Lancet HIV. 2014;1(2):e68–76. doi:.https://doi.org/10.1016/S2352-3018(14)70024-4
- Govindasamy D, Kranzer K, van Schaik N, Noubary F, Wood R, Walensky RP, et al. Linkage to HIV, TB and non-communicable disease care from a mobile testing unit in Cape Town, South Africa. PLoS One. 2013;8(11):e80017. doi:.https://doi.org/10.1371/journal.pone.0080017
- van Rooyen H, Barnabas RV, Baeten JM, Phakathi Z, Joseph P, Krows M, et al. High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2013;64(1):e1–8. doi:.https://doi.org/10.1097/QAI.0b013e31829b567d
- Hayes R, Floyd S, Schaap A, Shanaube K, Bock P, Sabapathy K, et al.; HPTN 071 (PopART) Study Team. A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial. PLoS Med. 2017;14(5):e1002292. doi:.https://doi.org/10.1371/journal.pmed.1002292
- Chamie G, Kwarisiima D, Clark TD, Kabami J, Jain V, Geng E, et al.; SEARCH Collaboration. Leveraging rapid community-based HIV testing campaigns for non-communicable diseases in rural Uganda. PLoS One. 2012;7(8):e43400. doi:.https://doi.org/10.1371/journal.pone.0043400
- Ayieko J, Petersen ML, Charlebois ED, Brown LB, Clark TD, Kwarisiima D, et al. A Patient-Centered Multicomponent Strategy for Accelerated Linkage to Care Following Community-Wide HIV Testing in Rural Uganda and Kenya. J Acquir Immune Defic Syndr. 2019;80(4):414–22. doi:.https://doi.org/10.1097/QAI.0000000000001939
- Maman D, Zeh C, Mukui I, Kirubi B, Masson S, Opolo V, et al. Cascade of HIV care and population viral suppression in a high-burden region of Kenya. AIDS. 2015;29(12):1557–65. doi:.https://doi.org/10.1097/QAD.0000000000000741
- Maman D, Chilima B, Masiku C, Ayouba A, Masson S, Szumilin E, et al. Closer to 90-90-90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study. J Int AIDS Soc. 2016;19(1):20673. doi:.https://doi.org/10.7448/IAS.19.1.20673
- Kelly JD, Schlough GW, Conteh S, Barrie MB, Kargbo B, Giordano TP. The Majority of the Pre-Antiretroviral Population Who Were Lost to Follow-Up Stopped Their Care in Freetown, Sierra Leone: A 12-Month Prospective Cohort Study Starting with HIV Diagnosis. PLoS One. 2016;11(2):e0149584. doi:.https://doi.org/10.1371/journal.pone.0149584
- Reddy EA, Agala CB, Maro VP, Ostermann J, Pence BW, Itemba DK, et al. Test site predicts HIV care linkage and antiretroviral therapy initiation: a prospective 3.5 year cohort study of HIV-positive testers in northern Tanzania. BMC Infect Dis. 2016;16(1):497. doi:.https://doi.org/10.1186/s12879-016-1804-8
- MacKellar D, Williams D, Bhembe B, Dlamini M, Byrd J, Dube L, et al. Peer-Delivered Linkage Case Management and Same-Day ART Initiation for Men and Young Persons with HIV Infection - Eswatini, 2015-2017. MMWR Morb Mortal Wkly Rep. 2018;67(23):663–7. doi:.https://doi.org/10.15585/mmwr.mm6723a3
- Govindasamy D, van Schaik N, Kranzer K, Wood R, Mathews C, Bekker LG. Linkage to HIV care from a mobile testing unit in South Africa by different CD4 count strata. J Acquir Immune Defic Syndr. 2011;58(3):344–52. doi:.https://doi.org/10.1097/QAI.0b013e31822e0c4c
- Aliyu MH, Blevins M, Parrish DD, Megazzini KM, Gebi UI, Muhammad MY, et al. Risk factors for delayed initiation of combination antiretroviral therapy in rural north central Nigeria. J Acquir Immune Defic Syndr. 2014;65(2):e41–9. doi:.https://doi.org/10.1097/QAI.0b013e31829ceaec
- Grobler A, Cawood C, Khanyile D, Puren A, Kharsany ABM. Progress of UNAIDS 90-90-90 targets in a district in KwaZulu-Natal, South Africa, with high HIV burden, in the HIPSS study: a household-based complex multilevel community survey. Lancet HIV. 2017;4(11):e505–13. doi:.https://doi.org/10.1016/S2352-3018(17)30122-4
- Boeke CE, Nabitaka V, Rowan A, Guerra K, Kabbale A, Asire B, et al. Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study. BMC Infect Dis. 2018;18(1):138. doi:.https://doi.org/10.1186/s12879-018-3042-8
- Sanga ES, Lerebo W, Mushi AK, Clowes P, Olomi W, Maboko L, et al. Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study. BMJ Open. 2017;7(4):e013733. doi:.https://doi.org/10.1136/bmjopen-2016-013733
- Parker LA, Jobanputra K, Rusike L, Mazibuko S, Okello V, Kerschberger B, et al. Feasibility and effectiveness of two community-based HIV testing models in rural Swaziland. Trop Med Int Health. 2015;20(7):893–902. doi:.https://doi.org/10.1111/tmi.12501
- Losina E, Bassett IV, Giddy J, Chetty S, Regan S, Walensky RP, et al. The “ART” of linkage: pre-treatment loss to care after HIV diagnosis at two PEPFAR sites in Durban, South Africa. PLoS One. 2010;5(3):e9538. doi:.https://doi.org/10.1371/journal.pone.0009538
- Clouse K, Pettifor AE, Maskew M, Bassett J, Van Rie A, Behets F, et al. Patient retention from HIV diagnosis through one year on antiretroviral therapy at a primary health care clinic in Johannesburg, South Africa. J Acquir Immune Defic Syndr. 2013;62(2):e39–46. doi:.https://doi.org/10.1097/QAI.0b013e318273ac48
- du Toit E, van Schalkwyk C, Dunbar R, Jennings K, Yang B, Coetzee D, et al. Missed opportunities for retention in pre-ART care in Cape Town, South Africa. PLoS One. 2014;9(5):e96867. doi:.https://doi.org/10.1371/journal.pone.0096867
- Fox MP, Shearer K, Maskew M, Meyer-Rath G, Clouse K, Sanne I. Attrition through multiple stages of pre-treatment and ART HIV care in South Africa. PLoS One. 2014;9(10):e110252. doi:.https://doi.org/10.1371/journal.pone.0110252
- Kranzer K, Zeinecker J, Ginsberg P, Orrell C, Kalawe NN, Lawn SD, et al. Linkage to HIV care and antiretroviral therapy in Cape Town, South Africa. PLoS One. 2010;5(11):e13801. doi:.https://doi.org/10.1371/journal.pone.0013801
- MacPherson P, Corbett EL, Makombe SD, van Oosterhout JJ, Manda E, Choko AT, et al. Determinants and consequences of failure of linkage to antiretroviral therapy at primary care level in Blantyre, Malawi: a prospective cohort study. PLoS One. 2012;7(9):e44794. doi:.https://doi.org/10.1371/journal.pone.0044794
- Genberg BL, Naanyu V, Wachira J, Hogan JW, Sang E, Nyambura M, et al. Linkage to and engagement in HIV care in western Kenya: an observational study using population-based estimates from home-based counselling and testing. Lancet HIV. 2015;2(1):e20–6. doi:.https://doi.org/10.1016/S2352-3018(14)00034-4
- Rentsch CT, Wringe A, Machemba R, Michael D, Urassa M, Todd J, et al. Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014-2017. Trop Med Int Health. 2018;23(12):1384–93. doi:.https://doi.org/10.1111/tmi.13153
- Courtenay-Quirk C, Geller AL, Duran D, Honwana N. Tracking linkage to care in an anonymous HIV testing context: A field assessment in Mozambique. J Eval Clin Pract. 2020;26(3):1005–12. doi:.https://doi.org/10.1111/jep.13262
- MacKellar DA, Williams D, Storer N, Okello V, Azih C, Drummond J, et al. Enrollment in HIV Care Two Years after HIV Diagnosis in the Kingdom of Swaziland: An Evaluation of a National Program of New Linkage Procedures. PLoS One. 2016;11(2):e0150086. doi:.https://doi.org/10.1371/journal.pone.0150086
- Meehan SA, Sloot R, Draper HR, Naidoo P, Burger R, Beyers N. Factors associated with linkage to HIV care and TB treatment at community-based HIV testing services in Cape Town, South Africa. PLoS One. 2018;13(4):e0195208. doi:.https://doi.org/10.1371/journal.pone.0195208
- Harklerode R, Todd J, de Wit M, Beard J, Urassa M, Machemba R, et al. Characterizing a Leak in the HIV Care Cascade: Assessing Linkage Between HIV Testing and Care in Tanzania. Front Public Health. 2020;7:406. doi:.https://doi.org/10.3389/fpubh.2019.00406
- Kayabu DE, Ngocho JS, Mmbaga BT. Effective linkage from point of HIV testing to care and treatment in Tanga region, Tanzania. PLoS One. 2018;13(8):e0201644. doi:.https://doi.org/10.1371/journal.pone.0201644
- Choko AT, MacPherson P, Webb EL, Willey BA, Feasy H, Sambakunsi R, et al. Uptake, Accuracy, Safety, and Linkage into Care over Two Years of Promoting Annual Self-Testing for HIV in Blantyre, Malawi: A Community-Based Prospective Study. PLoS Med. 2015;12(9):e1001873. doi:.https://doi.org/10.1371/journal.pmed.1001873
- Croxford S, Yin Z, Burns F, Copas A, Town K, Desai S, et al.; OptTEST project. Linkage to HIV care following diagnosis in the WHO European Region: A systematic review and meta-analysis, 2006-2017. PLoS One. 2018;13(2):e0192403. doi:.https://doi.org/10.1371/journal.pone.0192403
- Rosen S, Fox MP, Gill CJ. Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PLoS Med. 2007;4(10):e298. doi:.https://doi.org/10.1371/journal.pmed.0040298
- Sabapathy K, Hensen B, Varsaneux O, Floyd S, Fidler S, Hayes R. The cascade of care following community-based detection of HIV in sub-Saharan Africa - A systematic review with 90-90-90 targets in sight. PLoS One. 2018;13(7):e0200737. doi:.https://doi.org/10.1371/journal.pone.0200737
- Ruzagira E, Baisley K, Kamali A, Biraro S, Grosskurth H ; Working Group on Linkage to HIV Care. Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review. Trop Med Int Health. 2017;22(7):807–21. doi:.https://doi.org/10.1111/tmi.12888
- Mahle Gray K, Tang T, Shouse L, Li J, Mermin J, Hall HI. Using the HIV surveillance system to monitor the National HIV/AIDS Strategy. Am J Public Health. 2013;103(1):141–7. doi:.https://doi.org/10.2105/AJPH.2012.300859
- Hall HI, Halverson J, Wilson DP, Suligoi B, Diez M, Le Vu S, et al. Late diagnosis and entry to care after diagnosis of human immunodeficiency virus infection: a country comparison. PLoS One. 2013;8(11):e77763. doi:.https://doi.org/10.1371/journal.pone.0077763
- Piñeirúa A, Sierra-Madero J, Cahn P, Guevara Palmero RN, Martínez Buitrago E, Young B, et al. The HIV care continuum in Latin America: challenges and opportunities. Lancet Infect Dis. 2015;15(7):833–9. doi:.https://doi.org/10.1016/S1473-3099(15)00108-5
- Plazy M, Farouki KE, Iwuji C, Okesola N, Orne-Gliemann J, Larmarange J, et al.; Anrs 12249 Tasp Study Group. Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa. J Int AIDS Soc. 2016;19(1):20913. doi:.https://doi.org/10.7448/IAS.19.1.20913
- Joint United Nations Programme on HIV/AIDS (UNAIDS). Global AIDS update 2020. Available at: https://aids2020.unaids.org/report/) [accessed 2020 August 09].
- Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review. PLoS Med. 2011;8(7):e1001056. doi:.https://doi.org/10.1371/journal.pmed.1001056
- Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528(7580):S77–85. doi:.https://doi.org/10.1038/nature16044
- Layer EH, Kennedy CE, Beckham SW, Mbwambo JK, Likindikoki S, Davis WW, et al.; LTC Tanzania Collaborative Study Team. Multi-level factors affecting entry into and engagement in the HIV continuum of care in Iringa, Tanzania. PLoS One. 2014;9(8):e104961. doi:.https://doi.org/10.1371/journal.pone.0104961
- Watson-Jones D, Balira R, Ross DA, Weiss HA, Mabey D. Missed opportunities: poor linkage into ongoing care for HIV-positive pregnant women in Mwanza, Tanzania. PLoS One. 2012;7(7):e40091. doi:.https://doi.org/10.1371/journal.pone.0040091
- Wettstein C, Mugglin C, Egger M, Blaser N, Vizcaya LS, Estill J, et al.; IeDEA Southern Africa Collaboration. Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis. AIDS. 2012;26(18):2361–73. doi:.https://doi.org/10.1097/QAD.0b013e328359ab0c
- Tenthani L, Haas AD, Tweya H, Jahn A, van Oosterhout JJ, Chimbwandira F, et al. Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+') in Malawi. AIDS. 2014;28(4):589–98. doi:.https://doi.org/10.1097/QAD.0000000000000143
- MacCarthy S, Hoffmann M, Ferguson L, Nunn A, Irvin R, Bangsberg D, et al. The HIV care cascade: models, measures and moving forward. J Int AIDS Soc. 2015;18(1):19395. doi:.https://doi.org/10.7448/IAS.18.1.19395