Australian Treatment Cascade

At the beginning of January I wrote about New Year resolutions for our HIV management. That got me thinking about the treatment cascade. You may not have heard of it, so let me explain.

The HIV care and treatment cascade is a graph which helps us visualise the proportion of:

  • people with HIV in Australia,
  • those diagnosed,
  • linked to care,
  • retained in care,
  • receiving ART (treatment) and
  • having an undetectable viral load (UVL).

The Kirby Institute calculate of the 100% of people in Australia who are HIV-positive about 86% of people know they are living with HIV. 78% & 76% are linked and retained in care. 66% are receiving HIV treatment and 62% have an UVL.

Or as I like to describe:

72% who know they are HIV-positive are accessing HIV treatment and have an UVL’.

poz in oz figure 1

Figure 1: Estimates HIV care and treatment cascade in Australia at the end of 2013


So how are we doing compared to other countries?

Well at a conference in Glasgow in 2014 Raymond et al. presented an abstract on ‘Large disparities in HIV treatment cascades between eight European and high-income countries: analysis of break points.’ Or in other words, ‘How do treatment cascades from high income countries compare?’

Australia came in 1st place! We are estimated to have the highest proportion of people living with HIV on treatment with an UVL. I was surprised to find the United States at the bottom of the list, with only 25% having an UVL. This is lower than some sub-Saharan African countries where an estimated 29% of PLHIV have an UVL. Clinicians and public health officials can use these ‘cascades’ to help focus efforts and improve successes, such as increasing HIV testing or better referral pathways.

poz in oz figure 2

Figure 2: Treatment cascade in high-income countries

In Australia it looks like our 2015 HIV management resolutions are already in full swing. Now lets aim for the UNAIDS ambitious targets of 90:90:90. 90% of all people living with HIV knowing their HIV status, 90% of all people diagnosed with HIV receiving HIV treatment and 90% of all people receiving HIV treatment having an UVL.


Estimated HIV care and treatment cascade in Australia (best estimate and uncertainty bounds of plausible limits) “HIV in Australia: Annual Surveillance Report 2014 Supplement”

“Australia performs best in HIV treatment cascade – 62% with undetectable viral load”