The Cascade of Care, more commonly known as the HIV care continuum, is a calculation of how many people in a specific population diagnosed with HIV are initially linked to care, retained in care and have achieved viral suppression. It is an important tool in measuring success in controlling the HIV infection, identifying gaps in national HIV/AIDS strategies and set directions to improve care.
On behalf of EPIICC and REACH researchers, Anna Turkova presented on the Cascade of Care of HIV positive children and adolescents in three Russian centres at the International Workshop on HIV Paediatrics, which was held virtually in November this year. Russia currently has the highest number of HIV infections in the WHO European region, with more than 1 million people diagnosed with HIV. Half of all people living with HIV are receiving antiretroviral treatment (ART) and 70% have undetectable HIV levels. While Russia continues to make good progress it still has to overcome substantial shortfalls towards achieving the UNAIDS 90-90-90 targets. There are limited data on HIV care continuum among children and adolescents.
The EPPICC and REACH researchers have analysed the cascade of care on 922 children and adolescents from 3 Russian clinics, 703 of them were followed for no less than 12 months. Some of the key results from the study are depicted in the tables below.
Key results of all study participants
| Childhood Group (<10 years) | Adolescents Group (>10 years) | |
| ART initiated | 98 % | 81 % |
| Virological suppression at last visit | 78% | 46% |
| Good WHO immunological status | 94% | 83% |
Key results of participants who initiated ART
| Childhood Group (<10 years) | Adolescents Group (>10 years) | |
| Virological suppression at last visit | 82% | 51% |
| Good WHO immunological status | 94% | 79% |
In the adolescents’ group, females made up nearly 70%. These findings amplify the call for sexual and reproductive health education and preventative measures focused on the needs of young female adolescents.
Overall, the HIV care continuum shows good progress towards UNAIDS targets. The proportion of children who were on ART and achieved virological suppression increased over calendar years. A substantially lower proportion of young people diagnosed in adolescence initiated ART and were virologically suppressed. Timely ART initiation and support to adolescents in maintaining and adhering to treatment, remain vitally important to preserve individual well-being and eliminate the spread of HIV.
Anna Turkova is a paediatrician and research clinician, working at the MRC Clinical Trial Unit at UCL in London, and a key member of the Penta ID Network.
