The Cascade of Care: How HIV data models shape understanding of “monitoring and evaluation”, and “surveillance and survey”.

* Handayani, A., Hegarty, B., Pillai, P., Spreadborough, K. (2021) The Cascade of Care: How data models shape understanding of “monitoring and evaluation”, and “surveillance and survey”. DOI: https://doi.org/10.26188/14784783

*Authors listed in alphabetical order

This paper sets up the context in which the Cascade of Care is applied to HIV prevention in the Indonesian context. The Cascade of Care, hence forth referred to as the cascade, is a component of the broader Continuum of Care which is focused on the process from being at risk of HIV through to HIV prevention.

This paper first outlines the cascade as a data model, which is a core component of providing policy makers and funders a high-level picture of progress towards HIV prevention. The paper considers the implications of the 90/90/90 approach to HIV prevention - “90% of all persons living with HIV (PLHIV) are aware of their HIV status, 90% of all people who know their status are receiving antiretroviral therapy (ART), and 90% of those on ART are virally suppressed”.

The paper then considers two main components required to supply data to the cascade. First, monitoring and evaluation which emphasises that data should be used to drive decisions is examined. Second, surveillance and survey is considered which are the tools by which this data is collected. Throughout the paper, consideration is given to the purpose of the cascade and how the cascade shapes conceptualisation of these key terms. This paper provides a critique of how the cascade provides the appearance of a standard of HIV treatment and the broader implications of this.