Abstract
This chapter seeks to create further awareness and public health education on the importance of the human immunodeficiency virus (HIV) care continuum as one of the key policy focal areas to significantly reduce the HIV epidemic. Specific efforts were directed into the need to implement comprehensive HIV care continuum. The chapter argues that rolling out HIV counseling and testing, enrolled and linked patients to care, prescribing antiretroviral therapy, viral load testing and monitoring are key to achieve viral load suppression. Recommendations and future research direction have put much emphasis on an effort to address psychosocial factors such as stigma, inadequate healthcare facilities, laboratory testing equipment, social and cultural barriers to testing and treatment, to improve access and overall implementation of HIV care continuum.
TopBackground
Human immunodeficiency virus (HIV) is the virus that causes Acquired Immunodeficiency Syndrome (AIDS). AIDS is a serious, life-threatening illness that has a variety of symptoms (Stevens, Lynm, & Golub, 2012). Additionally, Stevens et al. (2012) assert that HIV infection can be treated with medication to make people living with HIV feel better and to prolong their lives. However, there is no cure for HIV infections or AIDS. Globally, 37.9 million people are living with HIV worldwide (WHO, 2018). The past three decades, human immunodeficiency virus (HIV) has united the international community in an unprecedented fashion. For example, in sub-Saharan Africa, the region with the highest incidence of HIV in the world (UNICEF, 2017).
Global epidemiology reports show that 90% (i.e., approximately 3 million) children and adolescents in sub-Saharan Africa live with HIV (UNICEF, 2017). In 2016, an estimated 80 000 new infections among children and adolescents were reported in Eastern and Southern Africa. In addition, adolescent girls (aged 15-19 accounted for approximately two-thirds of new HIV infections among young people (UNAIDS, 2015). With the advent of pediatric antiretroviral therapy (ART) and viral load suppression (Davies & Pinto, 2015; Ojikutu et al., 2014) efforts grassroots groups have mobilized policy makers, researchers, civil society and donor agencies from both developed and developing nations to respond to the epidemic (Webb, Cluver & Luo, 2018). The literature is replete with studies that have shown the significant progress that has been made with ART (Kline, 2006; Meyers et al., 2007; Ojikutu et al., 2014). For example, a systematic review of pediatric ART adherence research studies from middle and low-income countries, found that estimates of ART among this vulnerable population ranged from 49% to 76% of the studies reporting greater than 75% adherence (Vreeman et al., 2008).
Elimination of HIV epidemic by 2030 continues to be a global priority (WHO, 2014). The Joint United Nations Program on HIV/AIDS (UNAIDS) launched 90-90-90 targets to end AIDS by 2030. This simply means that 90% of people with HIV will be diagnosed, 90% of those diagnosed will be on antiretroviral therapy (ART), and 90% of those on ART will achieve viral suppression (Davies & Pinto, 2015). Even though achieving 90-90-90 targets should be done comprehensively and inclusively of each target, authors are stressing the easy access of HIV viral load testing and monitoring in order to achieve viral load suppression. According to WHO guidelines revised in 2010, they recommended the use of HIV viral load to detect or confirm treatment failure and to inform decisions about switching to second-line regime (WHO, 2010).
Key Terms in this Chapter
Viraemia: The presence of viruses in the blood.
Viral Load: This is the level of HIV in one’s blood. The main function of ART is to lower the viral load to levels below <40-75 copies/ml. Lower viral load means lower amounts of HIV function in the body.
HIV Care Continuum: A framework that guides the sequential steps of treatment care that people with HIV should go through from diagnosis and achieving sustained viral load suppression.
Viral Suppression: This is when antiretroviral therapy (ART) lowers an infected person’s viral load to an undetectable level, which means that the amount of HIV in one’s blood is very low. HIV-infected people with viral suppression are healthy and they can live longer.
Poor HIV Adherence: When HIV patients are missing their appointments and skipping their medicines which increases the chances of HIV to multiply and destroy their immune system. Poor adherence also contributes to high risk of drug resistance and treatment failure.
HIV Counseling and Testing: A public health intervention whereby individuals, family members, couples and community members receive HIV counseling and testing for prevention, treatment and support purposes. It is very important for each member of society to know his or her HIV status in order to prevent HIV transmission, to receive treatment on time, to receive care and support.
Antiretroviral Therapy: ART stands for a combination of drugs that suppress the human immunodeficiency virus (HIV) in order to reduce mortality and morbidity rates among HIV-infected people and to improve their quality of life.
Viral Load Tests: These tests are used to diagnose HIV infection in a blood sample and guide treatment choices.