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FIGURE 6-1 Implementation cascade for the continuum of care.
SOURCE: Adapted from Das, 2011, and IOM, 2012.

ment failure with the initiation of second-line treatment as needed. This chapter describes the committee’s assessment of PEPFAR’s efforts, focused on its activities to support the scale-up of service delivery, in each of the components of this continuum sequentially, providing for each some brief background and then following the program impact pathway framework of inputs, activities, and, to the extent possible, outcomes and impact of PEPFAR’s efforts.

The continuum of care described here is directed toward virological suppression and improved health, well-being, and survival for individuals who are HIV positive; however, another ultimate goal of the HIV response is a population-level reduction of the burden of HIV and of mortality due to HIV/AIDS. The contribution of PEPFAR to this aim, to the extent that it can be assessed, is discussed at the end of this chapter.

Although this chapter will focus on PEPFAR’s support for the provision of testing, care, and treatment services, it is also important to note that this continuum for care and treatment intersects with other services supported by PEPFAR programming and other opportunities where PEPFAR has a role in facilitating an effective response as well as where interrelated challenges that affect care and treatment can arise. These other program areas are discussed elsewhere in this report, including prevention services (Chapter 5), programs for orphans and vulnerable children (Chapter 7), and efforts to address gender-specific aspects of HIV (Chapter 8). Along with the intersection with these other services, care and treatment programs also are inextricably linked to elements of the health system, including infrastructure, commodities and supply chain, workforce, management, leadership, and financing that are required to support service delivery; these areas are



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