Prevention in Focus

Spring 2016 

The Cadillac of HIV care: The International Association of Providers in AIDS Care guidelines for optimizing the HIV care continuum

By Logan Broeckaert

Early, life-long treatment can allow a person with HIV to reach near-normal life expectancy.1 Early treatment also reduces rates of opportunistic infections, non-AIDS related disease and death,2 which improves quality of life for people living with HIV. Treatment can also substantially reduce the risk of passing HIV to sex partners when a person’s viral load is undetectable.3,4,5

Despite the availability of effective treatment, many people living with HIV in Canada are not adequately engaged in care.6,7,8 The International Association of Providers in AIDS Care (IAPAC), an international body that represents more than 17,000 clinicians, has developed the first comprehensive, evidence-based guidelines9 for improving engagement and retention of people living with HIV in the HIV care continuum (also known as the HIV treatment cascade). The aims of the guidelines are to increase HIV testing, linkage to care, treatment, engagement and retention in care, and viral suppression.

The guidelines focus on the clinical, behavioural, social and structural interventions that will improve access to and retention in HIV care. IAPAC’s 36 evidence-based recommendations are divided into six categories:

  • Optimizing the HIV care environment
  • Increasing HIV testing coverage and linkage to care
  • Increasing HIV treatment coverage
  • Increasing retention in care, HIV treatment adherence, and viral suppression
  • Adolescents
  • Metrics for and monitoring of the HIV care continuum

Frontline service providers, including AIDS service organizations, community health centres and public health units can implement many of the recommendations to better serve their clients. Using the recommendations as a foundation for effective programs and services will help us achieve the global testing and treatment targets set out by UNAIDS in its 90-90-90 strategy. Meeting these targets will allow us to end the spread of HIV by 2030.


IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents


  • 1. Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al. Closing the Gap: Increases in Life Expectancy among Treated HIV-Positive Individuals in the United States and Canada. Okulicz JF, editor. PLoS ONE. 2013 Dec 18;8(12):e81355.
  • 2. The INSIGHT START Study Group. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. New England Journal of Medicine. 2015 Jul 20;373(9):795–807. Available from:
  • 3. Cohen MS. Antiretroviral Treatment Prevents HIV Transmission: Final Results from the HPTN 052 Randomized Controlled Trial [Internet]. 8th IAS Conference on HIV Pathogenesis, Treatment, and Prevention; 2015 Jul 20 [cited 2015 Aug 17]; Vancouver, BC. Available from:
  • 4. Grulich AE, Bavinton B., Jin F. HIV Transmission in male serodiscordant couples in Australia, Thailand and Brazil. Late breaker poster 1019 LB presented at: 22nd Conference on Retroviruses and Opportunistic Infections; 2015 Feb 23; Seattle, WA.
  • 5. Rodger A. HIV Transmission Risk Through Condomless Sex If HIV+ Partner on Suppressive ART: Partner STUDY [Internet]. Oral presented at: Conference on Retroviruses and Opportunistic Infections; 2014 Mar 3 [cited 2014 Dec 4]; Boston, MA. Available from:
  • 6. Nosyk B, Montaner JSG, Colley G, Lima VD, Chan K, Heath K, et al. The cascade of HIV care in British Columbia, Canada, 1996–2011: a population-based retrospective cohort study. The Lancet Infectious Diseases. 2014 Jan;14(1):40–9.
  • 7. Gilbert M, Gardner S, Murray J, McGee F, Burchell A. Quantifying the HIV Care Cascade in Ontario: Challenges and Future Directions [Internet]. Poster presented at: 24th Annual Canadian Conference on HIV/AIDS Research; 2015 May 30; Toronto, Ontario. Available from:
  • 8. Lourenço L, Colley G, Nosyk B, Shopin D, Montaner JSG, Lima VD, et al. High Levels of Heterogeneity in the HIV Cascade of Care across Different Population Subgroups in British Columbia, Canada. Paraskevis D, editor. PLoS ONE. 2014 Dec 26;9(12):e115277.
  • 9. International Advisory Panel on HIV Care Continuum Optimization. IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. Journal of the International Association of Providers of AIDS Care. 2015 Nov 2 [cited 2015 Nov 13]; Available from:

About the author(s)

Logan Broeckaert holds a Master’s degree in History and is currently a researcher/writer at CATIE. Before joining CATIE, Logan worked on provincial and national research and knowledge exchange projects for the Canadian AIDS Society and the Ontario Public Health Association.