The HIV Prevention, Engagement and Care Cascade is a way of conceptualizing the care and support required to prevent HIV transmission and to support and treat people living with HIV. This model is used to identify gaps in current care, to evaluate care improvements, and to optimize the services and systems involved.
Initially referred to as the HIV Care Continuum, the model described stages of care that people living with HIV encounter from initial diagnosis through antiretroviral treatment and viral suppression. By measuring how many people reach each stage, how quickly they are doing so, and whether or not they are able to maintain improved health measures, the cascade assesses how well care systems are operating. The cascade measures how many people reach biomedical care goals like a suppressed viral load and also how many people are “engaged” in each stage, such as being able to see a doctor regularly or being able to access testing. It can also be used to compare the care that different priority populations receive to identify gaps that disproportionate affect specific populations.
The United Nations Programme on HIV/AIDS (UNAIDS) has set ambitious “90-90-90 goals” targeting three cascade measures. These targets propose that by 2020:
- 90% of people living with HIV will know their HIV status
- 90% of people living with HIV will be receiving sustained antiviral treatment
- 90% of people on treatment will have their HIV viral load suppressed
In Ontario, the HIV Prevention, Engagement and Care Cascade is a central part of Ontario’s HIV/AIDS Strategy. It sets goals for improved prevention, as well as engagement and care. Research provides the tools to monitor the cascade and to develop and test interventions that can improve cascade measures.