Critical Review: Building on the HIV Cascade: A Complementary "HIV States and Transitions" Framework for Describing HIV Diagnosis, Care, and Treatment at the Population Level

J Acquir Immune Defic Syndr. 2015 Jul 1;69(3):341-7. doi: 10.1097/QAI.0000000000000611.


The HIV cascade--often referred to as "the HIV continuum"--provides a valuable framework for population-level representations of engagement with the HIV healthcare system. The importance and appeal of this framework are evidenced by a large body of scientific literature, as well as by the adoption of cascade-related indicators by medical and public health organizations worldwide. Despite its centrality in the fields of HIV treatment and prevention, however, the traditional cascade provides limited description of the processes affecting the numbers it represents. Representations that describe these processes and capture the dynamic nature of HIV-infected persons' pathways through the healthcare system are essential for monitoring and predicting intervention effects and epidemic trends. We propose here a complementary schema--termed the "HIV States and Transitions" framework--designed to maintain key strengths of the traditional cascade while addressing key limitations and more fully describing the dynamic aspects of HIV testing, care, and treatment at the population level.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Case Management
  • Delivery of Health Care, Integrated
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / prevention & control*
  • Health Services Accessibility
  • Humans
  • Randomized Controlled Trials as Topic