People have to access and adhere to ART if HIV infection is to become a genuinely chronic disease. Unfortunately, even within the most advanced health-care systems, eff ective delivery of HIV-related care is far from ideal. The treatment cascade is now a commonly used conceptual model that quantifi es the delivery of services to people living with HIV across the entire continuum of care.4 To maximise the benefi ts of therapy at an individual and community level, at-risk individuals need fi rst to get tested, and those who are infected have to access care, start treatment, stay in care, and remain adherent to HIV therapy. In the USA, for every 100 patients with HIV infection, the US Centers for Disease Control and Prevention (CDC) estimates that only 28 patients have successfully managed each of these steps.