HIV Care Continuum in Adults and Children: Cost-Effectiveness Considerations

Authors: Katherine Harripersaud, Margaret McNairy, Saeed Ahmed, Elaine Abrams, Harsha Thirumurthy, Wafaa El-Sadr


This chapter discusses how progress in controlling the HIV epidemic depends on identification of individuals with HIV and their retention across the care continuum—from conducting HIV testing, linking HIV-positive individuals to care, retaining them in care, and achieving viral suppression. Nearly half of the 36.9 million living with HIV globally in 2014 were unaware of their infection, illustrating the need for testing. Linking to HIV care and treatment services after a positive HIV test is a critical step in the care continuum. Point-of-care testing increases the likelihood of timely access to care and initiation of ART. Barriers to retention in care come from financial constraints, inconvenience of clinic location and hours, and psychosocial factors. Adherence to an ART regimen is central for individual as well as population health by reducing transmission, and interventions to ensure patients take medication, promote peer education, and creation of community-based adherence clubs prove cost-effective. Enhancing just one step in the continuum is insufficient to achieve goals of control, so it is important to identify effective combinations of interventions that target multiple steps.