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    Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind.
    (2020-Oct) Grimsrud A; Wilkinson L; Eshun-Wilson I; Holmes C; Sikazwe I; Katz IT; Harvard Global Health Institute, Cambridge, MA, USA.; Massachusetts General Hospital Center for Global Health, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.; School of Medicine, Washington University, St Louis, MO, USA.; International AIDS Society, 3 Doris Road, Claremont, Cape Town, 7708, South Africa.; Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. anna.grimsrud@iasociety.org.; Center for Innovation in Global Health, Georgetown University, Washington, DC, USA.; Department of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; International AIDS Society, 3 Doris Road, Claremont, Cape Town, 7708, South Africa. anna.grimsrud@iasociety.org.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    PURPOSE OF REVIEW: Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. RECENT FINDINGS: There are opportunities to improve engagement both between testing and treatment and to support re-engagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management.