Five years after Treat All implementation: Botswana’s HIV response and future directions in the era of COVID-19

Background: As the relentless coronavirus disease-2019 (COVID-19) pandemic continues to spread across Africa, Botswana could face challenges maintaining the pathway towards control of its HIV epidemic.Objective: Utilising the Spectrum GOALS module (GOALS-2021), the 5-year outcomes from the implementation of the Treat All strategy were analysed and compared with the original 2016 Investment Case (2016-IC) projections. Future impact of adopting the new Joint United Nations Programme on HIV/AIDS (UNAIDS) Global AIDS Strategy (2021–2026) targets and macroeconomic analysis estimating how the financial constraints from the COVID-19 pandemic could impact the available resources for Botswana’s National HIV Response through 2030 were also considered.Method: Programmatic costs, population demographics, prevention and treatment outputs were determined. Previous 2016-IC data were uploaded for comparison, and inputs for the GOALS, AIM, DemProj, Resource Needs and Family Planning modules were derived from published reports, strategic plans, programmatic data and expert opinion. The economic projections were recalibrated with consideration of the impact of the COVID-19 pandemic.Results: Decreases in HIV infections, incidence and mortality rates were achieved. Increases in laboratory costs were offset by estimated decreases in the population of people living with HIV (PLWH). Moving forward, young women and others at high risk must be targeted in HIV prevention efforts, as Botswana transitions from a generalised to a more concentrated epidemic.Conclusion: The Treat All strategy contributed positively to decreases in new HIV infections, mortality and costs. If significant improvements in differentiated service delivery, increases in human resources and HIV prevention can be realised, Botswana could become one of the first countries with a previously high-burdened generalised HIV epidemic to gain epidemic control, despite the demands of the COVID-19 pandemic.

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Estimates of the Number of People Living with HIV in Italy

BioMed Research International ◽

10.1155/2014/209619 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 14

Author(s):

Laura Camoni ◽

Vincenza Regine ◽

Karen Stanecki ◽

Maria Cristina Salfa ◽

Mariangela Raimondo ◽

...

Keyword(s):

United Nations ◽

Hiv Infections ◽

Hiv Prevalence ◽

People Living With Hiv ◽

Joint United Nations Programme ◽

Need Of Care ◽

Nations Programme ◽

United Nations Programme ◽

Living With Hiv ◽

Hiv Aids

Objective. To estimate the HIV prevalence and the number of people living with HIV (PLHIV) in Italy with a projection for 2020.Methods. Two methods elaborated by Joint United Nations Programme on HIV/AIDS (UNAIDS) were used: Estimate and Projection Package and Spectrum.Results. A total of 123,000 (115,000–145,000) individuals aged 15 or more were estimated to be living with HIV in Italy at the end of 2012 and the estimated HIV prevalence was 0.28 (0.24–0.32) per 100 residents aged 15 or more. In 2012, the estimated number of new HIV infections among adults was 3,000 (2,700–4,000), and the number of adults in need for ART was 93,000 (80,000–110,000). The projection estimates that 130,000 (110,000–150,000) adults will live with HIV/AIDS in 2020 in Italy.Conclusion. Estimates of PLHIV in Italy stress the high number of PLHIV in need of care and treatment, as well as the need for more information and prevention campaigns.

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Stigma and discrimination: Barrier for ending AIDS by 2030 and achieving the 90-90-90 targets by 2020

Public Health and Preventive Medicine Archive ◽

10.15562/phpma.v7i1.206 ◽

2019 ◽

Vol 7 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Dewa Nyoman Wirawan

Keyword(s):

Antiretroviral Therapy ◽

Viral Suppression ◽

Hiv Infections ◽

People Living With Hiv ◽

Hiv Status ◽

Hiv Epidemic ◽

Nations Programme ◽

United Nations Programme ◽

Public Health Threat ◽

Living With Hiv

The Joint United Nations Programme on HIV-AIDS (UNAIDS) put forward an ambitious vision of “three zero” which consisted of zero new HIV infections, zero discrimination and zero AIDS-related deaths. In other words, it is envisaged there will be no new HIV infections, no more discrimination towards people living with HIV and no more AIDS-related deaths. UNAIDS also set the target of “ending AIDS” as a public health threat by 2030. In order to end the HIV epidemic by 2030, in 2014 UNAIDS established a fast tract strategy namely "90-90-90" which means by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained access to antiretroviral therapy (ART) and 90% of all people receiving antiretroviral therapy will achieve viral suppression. If this target of "90-90-90" is achieved, it is estimated that by 2020 at least 73% of all people living with HIV worldwide will experience viral suppression; further modeling suggests that if this target is achieved this will bring about the “end of AIDS” by 2030.

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New action points in the fight against HIV/AIDS in Europe and Central Asia

Weekly releases (1997–2007) ◽

10.2807/esw.08.39.02553-en ◽

2004 ◽

Vol 8 (39) ◽

Author(s):

Keyword(s):

European Union ◽

United Nations ◽

Central Asia ◽

Hiv Infections ◽

People Living With Hiv ◽

The European Union ◽

Nations Programme ◽

United Nations Programme ◽

Living With Hiv ◽

Hiv Aids

As numbers of new HIV infections increase across the European Union, and figures from the Joint United Nations Programme on HIV/AIDS (UNAIDS) show over 1.8 million people living with HIV in Europe and Central Asia, the European Commission wants attention refocused on the problem

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Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health

BMC Public Health ◽

10.1186/s12889-021-10296-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristie C. Waterfield ◽

Gulzar H. Shah ◽

Gina D. Etheredge ◽

Osaremhen Ikhile

Keyword(s):

Public Health ◽

Health Care ◽

Clinical Care ◽

Hiv Infections ◽

People Living With Hiv ◽

Negative Consequences ◽

Persons Who Inject Drugs ◽

Persons Living With Hiv ◽

Living With Hiv ◽

The Impact

Abstract Background With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. Discussion As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. Conclusion Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

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Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

Sexual Health ◽

10.1071/sh16052 ◽

2017 ◽

Vol 14 (1) ◽

pp. 111 ◽

Cited By ~ 15

Author(s):

Graham Brown ◽

William Leonard ◽

Anthony Lyons ◽

Jennifer Power ◽

Dirk Sander ◽

...

Keyword(s):

Hiv Prevention ◽

Gay Men ◽

Sexual Minorities ◽

Research Policy ◽

Scale Up ◽

People Living With Hiv ◽

Structural Level ◽

Biomedical Technologies ◽

Living With Hiv ◽

The Impact

Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM’s access to and use of these technologies. At the personal level, stigma can affect individual gay men’s sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM’s incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma.

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Setting the scene, setting the targets. The Joint United Nations Programme on HIV/AIDS prevention targets of 2016 and estimating global pre-exposure prophylaxis targets

Sexual Health ◽

10.1071/sh18147 ◽

2018 ◽

Vol 15 (6) ◽

pp. 485 ◽

Cited By ~ 4

Author(s):

Rosalind Coleman

Keyword(s):

United Nations ◽

Hiv Infections ◽

Joint United Nations Programme ◽

Hiv Interventions ◽

Nations Programme ◽

United Nations Programme ◽

Substantial Risk ◽

Exposure Prophylaxis ◽

Priority Populations ◽

Hiv Aids

Commitment to ambitious and time-bound targets for HIV interventions has been part of the response from the beginning of the HIV epidemic. The Joint United Nations Programme on HIV/AIDS (UNAIDS) HIV primary prevention workA is built on five pillars that include offering pre-exposure prophylaxis (PrEP) to population groups at substantial risk of HIV infection. After a slow start, countries are now setting coverage targets for PrEP, but the weakness of epidemiological, demographic and behavioural data at subnational level in many countries where there is a high burden of new HIV infections, makes it difficult to define the locations and populations where to offer PrEP. This article reviews the history and challenges of PrEP target setting and suggests some possible ways of strengthening the process. Reviewing program data will identify gaps in reaching key and other priority populations for whom coverage targets were set and help to refine the offer of PrEP.

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The potential impact of urine-LAM diagnostics on tuberculosis incidence and mortality: A modelling analysis

PLoS Medicine ◽

10.1371/journal.pmed.1003466 ◽

2020 ◽

Vol 17 (12) ◽

pp. e1003466

Author(s):

Saskia Ricks ◽

Claudia M. Denkinger ◽

Samuel G. Schumacher ◽

Timothy B. Hallett ◽

Nimalan Arinaminpathy

Keyword(s):

Population Level ◽

Credible Interval ◽

Hiv Care ◽

People Living With Hiv ◽

Country Level ◽

Incidence And Mortality ◽

The Status ◽

Epidemiological Impact ◽

Incident Cases ◽

The Impact

Background Lateral flow urine lipoarabinomannan (LAM) tests could offer important new opportunities for the early detection of tuberculosis (TB). The currently licensed LAM test, Alere Determine TB LAM Ag (‘LF-LAM’), performs best in the sickest people living with HIV (PLHIV). However, the technology continues to improve, with newer LAM tests, such as Fujifilm SILVAMP TB LAM (‘SILVAMP-LAM’) showing improved sensitivity, including amongst HIV-negative patients. It is important to anticipate the epidemiological impact that current and future LAM tests may have on TB incidence and mortality. Methods and findings Concentrating on South Africa, we examined the impact that widening LAM test eligibility would have on TB incidence and mortality. We developed a mathematical model of TB transmission to project the impact of LAM tests, distinguishing ‘current’ tests (with sensitivity consistent with LF-LAM), from hypothetical ‘future’ tests (having sensitivity consistent with SILVAMP-LAM). We modelled the impact of both tests, assuming full adoption of the 2019 WHO guidelines for the use of these tests amongst those receiving HIV care. We also simulated the hypothetical deployment of future LAM tests for all people presenting to care with TB symptoms, not restricted to PLHIV. Our model projects that 2,700,000 (95% credible interval [CrI] 2,000,000–3,600,000) and 420,000 (95% CrI 350,000–520,000) cumulative TB incident cases and deaths, respectively, would occur between 2020 and 2035 if the status quo is maintained. Relative to this comparator, current and future LAM tests would respectively avert 54 (95% CrI 33–86) and 90 (95% CrI 55–145) TB deaths amongst inpatients between 2020 and 2035, i.e., reductions of 5% (95% CrI 4%–6%) and 9% (95% CrI 7%–11%) in inpatient TB mortality. This impact in absolute deaths averted doubles if testing is expanded to include outpatients, yet remains <1% of country-level TB deaths. Similar patterns apply to incidence results. However, deploying a future LAM test for all people presenting to care with TB symptoms would avert 470,000 (95% CrI 220,000–870,000) incident TB cases (18% reduction, 95% CrI 9%–29%) and 120,000 (95% CrI 69,000–210,000) deaths (30% reduction, 95% CrI 18%–44%) between 2020 and 2035. Notably, this increase in impact arises largely from diagnosis of TB amongst those with HIV who are not yet in HIV care, and who would thus be ineligible for a LAM test under current guidelines. Qualitatively similar results apply under an alternative comparator assuming expanded use of GeneXpert MTB/RIF (‘Xpert’) for TB diagnosis. Sensitivity analysis demonstrates qualitatively similar results in a setting like Kenya, which also has a generalised HIV epidemic, but a lower burden of HIV/TB coinfection. Amongst limitations of this analysis, we do not address the cost or cost-effectiveness of future tests. Our model neglects drug resistance and focuses on the country-level epidemic, thus ignoring subnational variations in HIV and TB burden. Conclusions These results suggest that LAM tests could have an important effect in averting TB deaths amongst PLHIV with advanced disease. However, achieving population-level impact on the TB epidemic, even in high-HIV-burden settings, will require future LAM tests to have sufficient performance to be deployed more broadly than in HIV care.

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The Benefits of Immediate ART

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219831714 ◽

2019 ◽

Vol 18 ◽

pp. 232595821983171 ◽

Cited By ~ 2

Author(s):

Yan Zhao ◽

Jennifer M. McGoogan ◽

Zunyou Wu

Keyword(s):

World Health ◽

Hiv Care ◽

Hiv Diagnosis ◽

Hiv Care Cascade ◽

Art Initiation ◽

Care Cascade ◽

Nations Programme ◽

United Nations Programme ◽

Health Organization ◽

Treat All

The benefits of “early” antiretroviral therapy (ART; ie, initiation when CD4 ≥500 cells/mm3) are now well accepted as reflected in the removal of the CD4-based eligibility from new ART guidelines by the World Health Organization (WHO). However, neither the “treat-all” strategy recommendations presented in the guidelines nor the HIV care cascade goals in the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets adequately address the issue of ART timing. Our recent study on “immediate” ART (ie, ≤30 days after HIV diagnosis) adds important evidence demonstrating the real and meaningful benefits of rapid ART initiation even among those who have CD4 ≥500 cells/mm3. We call on WHO and UNAIDS to consider this research and encourage a shift from the treat-all strategy to an “immediately-treat-all” strategy, and from a slow, fragmented, complicated, multistep HIV care cascade to a fast, easy, and simple cascade with effectiveness measures that incorporate the important aspect of time.

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International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012–2019

BMJ Open ◽

10.1136/bmjopen-2019-035246 ◽

2020 ◽

Vol 10 (5) ◽

pp. e035246 ◽

Cited By ~ 5

Author(s):

Frédérique Chammartin ◽

Cam Ha Dao Ostinelli ◽

Kathryn Anastos ◽

Antoine Jaquet ◽

Ellen Brazier ◽

...

Keyword(s):

Drug Resistance ◽

Clinical Stage ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Loss To Follow Up ◽

Sub Saharan ◽

Treat All ◽

The Impact ◽

International Epidemiology

PurposeThe objectives of the International epidemiology databases to evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and coinfections and (iv) to examine the pregnancy-related and HIV-related outcomes of women on ART and their infants exposed to HIV or ART in utero or via breast milk.ParticipantsIeDEA is organised in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled.Findings to dateThe data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in PLWHIV-1 or PLWHIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of coinfection with hepatitis B and C, and the epidemiology of different cancers and of (multidrug resistant) tuberculosis, renal disease and of mental illness. The adoption of ‘Treat All’, making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic.Future plansIeDEA has formulated several research priorities for the ‘Treat All’ era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.

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Predicting the population impact of increased HIV testing and treatment in Australia

Sexual Health ◽

10.1071/sh13069 ◽

2014 ◽

Vol 11 (2) ◽

pp. 146 ◽

Cited By ~ 16

Author(s):

James Jansson ◽

Cliff C. Kerr ◽

David P. Wilson

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infections ◽

Transmission Risk ◽

Risk Compensation ◽

Treatment As Prevention ◽

People Living With Hiv ◽

Risk Levels ◽

Sex With Men ◽

Living With Hiv ◽

The Impact

Introduction The treatment as prevention strategy has gained popularity as a way to reduce the incidence of HIV by suppressing viral load such that transmission risk is decreased. The effectiveness of the strategy also requires early diagnosis. Methods: Informed by data on the influence of diagnosis and treatment on reducing transmission risk, a model simulated the impact of increasing testing and treatment rates on the expected incidence of HIV in Australia under varying assumptions of treatment efficacy and risk compensation. The model utilises Australia’s National HIV Registry data, and simulates disease progression, testing, treatment, transmission and mortality. Results: Decreasing the average time between infection and diagnosis by 30% is expected to reduce population incidence by 12% (~126 cases per year, 95% confidence interval (CI): 82–198). Treatment of all people living with HIV with CD4 counts <500 cells μL–1 is expected to reduce new infections by 30.9% (95% CI: 15.9–37.6%) at 96% efficacy if no risk compensation occurs. The number of infections could increase up to 12.9% (95% CI: 20.1–7.4%) at 26% efficacy if a return to prediagnosis risk levels occur. Conclusion: Treatment as prevention has the potential to prevent HIV infections but its effectiveness depends on the efficacy outside trial settings among men who have sex with men and the level of risk compensation. If antiretroviral therapy has high efficacy, risk compensation will not greatly change the number of infections. If the efficacy of antiretroviral therapy is low, risk compensation could lead to increased infections.

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