From acute to chronic - HIV care in the era of widely, available antiretroviral therapy in low resource settings.

Mugglin, Catrina (2020). From acute to chronic - HIV care in the era of widely, available antiretroviral therapy in low resource settings. (Unpublished). (Dissertation, University of Bern, Faculty of Medicine, the Faculty of Science and the Vetsuisse Faculty)

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Worldwide an estimated 38 million people are living with HIV, of which 25.4 million are on treatment. Antiretroviral therapy (ART) suppresses viral replication, stops HIV disease progression, and reduces HIV transmission. This year marks the year the ambitious Joint United Nations Programme on HIV/AIDS (UNAIDS) global HIV testing and treatment goals to end the epidemic by 2030 were aspired to be met. By 2020, 90% of all people living with HIV (PLWH) should know their status, 90% of all PLWH should be on ART, and, finally, 90% of those on ART should have viral suppression. The series of steps from HIV diagnosis through successful treatment to viral suppression can be described as the HIV care cascade or HIV care continuum. The HIV care cascade can be used to assess outcomes for PLWH on an individual level as well as on a population level. Retention on ART remains an essential part of the cascade. To reach sustained viral suppression, PLWH need to stay on a lifelong treatment with ART. As the provision of ART increases and with the broad implementation of the treat-all guidelines, PLWH start ART earlier and PLWH live longer and healthier lives. HIV has become a chronic condition and as PLWH age, non-communicable diseases (NCDs) increasingly affect them. How do we track and measure the UNAIDS targets? What are the gaps along the HIV care cascade? Furthermore, what challenges occur with an aging population of PLWH?

In my PhD thesis, I aimed to study HIV as a chronic disease in the context of staying on ART and aging with HIV. I desired to investigate the challenges and opportunities involved in lifelong treatment of HIV, with a focus on resource-limited settings. The first aim of the thesis focuses on the HIV care continuum. Our objective was to investigate the HIV care continuum, as well as to assess retention on ART. The second aim of this thesis focuses on the intersection of NCD and HIV as well as to evaluate the integration of NCD care into the HIV care framework.

Item Type:	Thesis (Dissertation)
Division/Institute:	04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
Graduate School:	Graduate School for Cellular and Biomedical Sciences (GCB)
UniBE Contributor:	Mugglin, Catrina Andrea, Egger, Matthias, Keiser, Olivia
Subjects:	600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services
Language:	English
Submitter:	Doris Kopp Heim
Date Deposited:	11 Jul 2024 15:24
Last Modified:	11 Jul 2024 15:24
Additional Information:	Doctor of Medicine and Philosophy (MD,PhD)
URI:	https://boris.unibe.ch/id/eprint/198922