A Database of Randomized Trials on the HIV Care Cascade (CASCADE Database): Descriptive Study

Background The Joint United Nations Programme on HIV/AIDS has set targets for 2025 regarding people living with HIV. For these targets to be met, 95% of people with HIV would need to know their HIV status, 95% of people with HIV would need to be receiving antiretroviral therapy, and 95% of people on antiretroviral therapy would need to be virally suppressed. Some countries are on track to meet these targets. However, within and across countries, several vulnerable populations may not meet these targets. This is in part because several approaches to improving the cascade of care after an HIV diagnosis are not tailored to and are not appropriate for vulnerable populations, such as men who have sex with men, sex workers, people who inject drugs, Black people, people in prisons, women, and youth. To inform research, policy, and practice, there is a need for curated data on HIV care cascade research. Objective The CASCADE database is a repository of randomized clinical HIV trials. It was designed to inform, support, and improve HIV care cascade research, systematic reviews, and evidence maps. Methods PubMed, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Library were searched to obtain randomized trials that were designed to address at least one of the following care cascade outcomes: the initiation of therapy, adherence to medication, retention in care, and engagement in care. Data were screened and extracted in duplicate using DistillerSR software (Evidence Partners Incorporated) and were cataloged based on the following features: year, income level, setting, the delivery of the intervention, the population receiving the intervention, intervention type, and the level of pragmatism of the intervention. Results A total of 298 HIV clinical trials are included in the CASCADE database, of which 162 (54.4%) were conducted in high-income countries, and 116 (38.9%) targeted vulnerable populations. Adherence to antiretroviral therapy was the most investigated HIV care cascade outcome (216/298, 72.5%), followed by retention in care (34/298, 11.4%). CASCADE has a user-friendly interface with simple and advanced search features. The CASCADE database has inspired 2 methodological papers and 13,567 website visits from over 10 countries. Conclusions CASCADE is the first database dedicated to trials that focus on the HIV care cascade, and it can be used for systematic reviews, evidence maps, and methodological research. It is freely accessible, and the data can be downloaded in CSV format.