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IntroductionThis article seeks to identify where delays occur along the adult HIV care cascade ("the cascade"), to improve understanding of what constitutes "delay" at each stage of the cascade and how this can be measured across a range of settings and to inform service delivery efforts. Current metrics are reviewed, measures informed by global guidelines are suggested and areas for further clarification are underscored.DiscussionQuestions remain on how best to evaluate late entry into each stage of the cascade. The delayed uptake of HIV testing may be more consistently measured once rapid CD4 testing is administered at the time of HIV testing. For late enrolment, preliminary research has begun to determine how different time intervals for linking to HIV care affect individual health. Regarding treatment, since 2013, the World Health Organization (WHO) and UNAIDS recommend treatment initiation when CD4 <500 cells/mm3; these guidelines provide a useful albeit evolving threshold to define late treatment initiation. Finally, WHO guidelines for high‐, low‐ and middle‐income countries also could be used to standardize measures for achieving viral suppression.ConclusionsThere is no "one size fits all" model as the provision of services may differ based on a range of factors. Nonetheless, measures informed by global guidelines are needed to more consistently evaluate the scope of and factors associated with delays to each stage of the cascade. Doing so will help identify how practitioners can best deliver services and facilitate access to and continued engagement in care.

The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.

Background: There are few studies on HIV subtypes and primary and secondary antiretroviral drug resistance (ADR) in community-recruited samples in Brazil. We analyzed HIV clade diversity and prevalence of mutations associated with ADR in men who have sex with men in all five regions of Brazil.Methods: Using respondent-driven sampling, we recruited 3515 men who have sex with men in nine cities: 299 (9.5%) were HIV-positive; 143 subjects had adequate genotyping and epidemiologic data. Forty-four (30.8%) subjects were antiretroviral therapy-experienced (AE) and 99 (69.2%) antiretroviral therapy-naive (AN). We sequenced the reverse transcriptase and protease regions of the virus and analyzed them for drug resistant mutations using World Health Organization guidelines.Results: the most common subtypes were B (81.8%), C (7.7%), and recombinant forms (6.9%). the overall prevalence of primary ADR resistance was 21.4% (i.e. among the AN) and secondary ADR was 35.8% (i.e. among the AE). the prevalence of resistance to protease inhibitors was 3.9% (AN) and 4.4% (AE); to nucleoside reverse transcriptase inhibitors 15.0% (AN) and 31.0% (AE) and to nonnucleoside reverse transcriptase inhibitors 5.5% (AN) and 13.2% (AE). the most common resistance mutation for nucleoside reverse transcriptase inhibitors was 184V (17 cases) and for nonnucleoside reverse transcriptase inhibitors 103N (16 cases).Conclusions: Our data suggest a high level of both primary and secondary ADR in men who have sex with men in Brazil. Additional studies are needed to identify the correlates and causes of antiretroviral therapy resistance to limit the development of resistance among those in care and the transmission of resistant strains in the wider epidemic. ; Ministry of Health/Secretariat of Health Surveillance/Department of STD, AIDS and Viral Hepatitis through Brazilian Government ; Ministry of Health/Secretariat of Health Surveillance/Department of STD, AIDS and Viral Hepatitis through United Nations Office on Drugs and Crime-UNODC ; Department of STD, AIDS and Viral Hepatitis of the Ministry of Health ; Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) ; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) ; Univ Fed Ceara, Dept Saude Comunitaria, BR-60430971 Fortaleza, Ceara, Brazil ; Universidade Federal de São Paulo, São Paulo, Brazil ; Tulane Univ, Sch Publ Hlth & Trop Med, New Orleans, LA USA ; Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil ; Univ Fed Bahia, Inst Saude Colet, BR-41170290 Salvador, BA, Brazil ; Univ Fed Rio de Janeiro, Rio de Janeiro, Brazil ; Univ Brasilia, BR-70910900 Brasilia, DF, Brazil ; Univ Calif San Francisco, San Francisco, CA 94143 USA ; Univ São Paulo, LIM 03, São Paulo, Brazil ; Universidade Federal de São Paulo, São Paulo, Brazil ; Ministry of Health/Secretariat of Health Surveillance/Department of STD, AIDS and Viral Hepatitis through Brazilian Government: AD/BRA/03/H34 ; Ministry of Health/Secretariat of Health Surveillance/Department of STD, AIDS and Viral Hepatitis through United Nations Office on Drugs and Crime-UNODC: AD/BRA/03/H34 ; Department of STD, AIDS and Viral Hepatitis of the Ministry of Health: CSV 234/07 ; FAPESP: 2004/15856-9 ; CAPES: BEX 3495/06-0 ; Web of Science