Treatment Growth and Retention

Speeches Shim

Nurse weighing patient in family planning sector in Sofala.
Nurse weighing patient in family planning sector in Sofala.
Photo credit: ECHO/Mozambique

Antiretroviral therapy (ART) stops the replication of the HIV virus inside a person infected with HIV, affording the body’s immune system time to recover and rebuild itself. While not curative, these medicines are powerful, with studies suggesting that people living with HIV (PLHIV) can achieve near-normal life expectancies when taking ART. In addition, by lowering the amount of HIV virus in the body, antiretroviral drugs (ARVs) help reduce the chance that an HIV-positive individual transmits the infection to an HIV-negative partner. At the end of 2019, 38 million people were living with HIV worldwide, with approximately 68 percent accessing lifesaving antiretroviral therapy (ART) as of the end of June 2020.

Since USAID’s first investments 35 years ago in fighting HIV there has been significant progress, impacting the lives of millions of people living with HIV and their families. From cutting-edge therapeutics to innovative service delivery models to rigorous data analytics and strengthening health systems, USAID has been at the forefront to support comprehensive ART programs around the globe to ensure those who need it have access to lifesaving treatment and achieve optimal health outcomes and high quality of life.

In spite of the severity of the challenges posed by the HIV epidemic, global access to ART has increased substantially since 2003, with 26 million people accessing ART as of June 2020. Access to these lifesaving treatments has reduced the numbers of AIDS-related deaths by 60 percent since the peak in 2004. Over 17 million people are supported directly by U.S. Government assistance under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The U.S. Government is the world’s largest donor to HIV and AIDS programs worldwide, having invested over $90 billion through PEPFAR in the HIV response, with much of that support managed by USAID. USAID supports comprehensive ART programs to improve access to quality HIV care and treatment services and provides lifesaving ART to 6.2 million people living with HIV globally through the provision of high-quality, client-centered comprehensive HIV clinical services.

USAID Impact

Robust Antiretroviral Therapy Programs to Improve Health, Reduce Transmission, and Build Stronger Health Systems

USAID-supported treatment programs ensure all newly diagnosed individuals are immediately placed on robust optimized HIV treatment regimens and are provided support to stay on lifelong treatment in order to achieve viral load suppression. Successful treatment and achieving viral load suppression also prevents transmission and continued progress towards epidemic control. Ensuring all clients have access to continuous, uninterrupted ART requires programs to be tailored to meet their needs. USAID does this through the high-quality implementation of best practices and innovative interventions to reduce barriers to HIV treatment and support services, including those most vulnerable, such as children and adolescents living with HIV; pregnant and breastfeeding women and their infants; and key populations.

USAID-supported ART programs focus on three key priorities to ensure lifelong continuity of treatment to ultimately achieve viral load suppression (VLS) and optimal health outcomes for all clients:

  1. Improving access to optimized ART for all PLHIV to achieve viral load suppression
  2. Improving the quality of ART services to ensure clients can easily engage in treatment services and have access to lifelong continuous ART
  3. Fostering sustainability of lifelong HIV treatment services to ensure a robust and resilient health system that can maintain high-quality services and effectively respond to ongoing challenges and other new or emerging health threats

To accomplish these priorities, USAID and its implementing partners have utilized a variety of innovative programmatic approaches. They include:

  • Implementing innovative and client-centered interventions such as multi-month dispensing and decentralized drug delivery to increase flexibility and reduce the burden on clients in order to access treatment more easily.
  • Using technologies, like mobile phones and automated drug pick up points, to help support patient adherence to medication and health care.
  • Making care more accessible through client-centered differentiated service delivery models, including increasing patient adherence support and treatment access.
  • Pooling procurement and utilizing generic antiretroviral medicines to lower the price of HIV medicines ten-fold in order to accelerate access to the most effective and robust HIV treatment regimens in resource-limited settings.
  • Task sharing and creative deployment of professional and lay health care workers to ensure patients can receive the highest quality services they need and where they prefer to use those services.
  • Developing robust information systems for clinical settings and for the management of commodities; using these systems to improve the quality of care provided to clients.
Psychosocial support officer offering counseling to a caregiver in Sofala.
Psychosocial support officer offering counseling to a caregiver in Sofala.
Photo credit: ECHO/Mozambique

2020 Achievements

Despite the significant impact of the COVID-19 pandemic on the livelihood and health of people across the globe and the disruptions to health systems and other critical infrastructure such as supply chain and logistics, USAID treatment programs maintained critical services and continued to advance HIV policy and technical priorities through innovative adaptations.


  • Provided HIV treatment services to 6,280,907 PLHIV across 21 countries and three regional programs.
  • Initiated 942, 317 newly diagnosed people on lifesaving ART.
  • Continued scale-up of viral load testing, with 75 percent of eligible clients on ART having received a viral load test within the past 12 months (by the end of FY20).
  • Successfully achieved viral load suppression in 92 percent of all clients on ART who received a viral load test in the past 12 months.
  • Continued to scale the transition to optimized HIV treatment regimens, including the current WHO-recommended first line regimen Tenofovir-Lamivudine-Dolutegravir (TLD).

Additional Resources

Last updated: May 13, 2021

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