Beyond the HIV Care Cascade: A Rapid Review of Patient Trajectories, Care Transitions and Multistate Modeling Approaches

The conventional HIV care cascade reports cross-sectional proportions and conceals repeated movement between care states. This rapid review examined how studies published from 2021 to 2026 document patient trajectories, care transitions, and multistate modeling in HIV care. Searches were run on 12 October 2026 with a general web search tool because bibliographic database counts could not be obtained; one reviewer screened 47 records, and most full texts were inaccessible, so extraction is largely abstract-level. Thirteen studies were included: six multistate analyses, one descriptive cyclical-cascade study, three group-based trajectory analyses, and three competing-risk analyses. Disengagement and re-engagement recurred across studies from Africa and North America, and loss to follow-up often conflated transfer, death, and disengagement. Younger age, depression, alcohol use, travel distance, and health-system factors were associated with transitions in individual studies. Definitions of disengagement ranged from 28 days to 18 months, which prevented pooling, and no study modeled diagnosis-to-linkage transitions. The evidence is heterogeneous and associational. Standardized state definitions, explicit handling of transfers and mortality, and complete database searching are needed.