Maximizing the impact of HIV prevention technologies in sub-Saharan Africa
There have been substantial gains in the range and efficacy of technologies available for HIV prevention, with voluntary medical male circumcision (VMMC), treatment as prevention, and pre-exposure prophylaxis (PrEP) being added to the existing toolbox of condoms, lubricant, behaviour change, harm reduction, structural interventions and advocacy programmes. These advances led to the optimism of calls to end the AIDS epidemic by 2030 with a target of fewer than 500,000 new cases a year by 2020 and 200,000 by 2030 . However, progress towards these goals is slow with an estimated 1.9 million new infections in 2017 globally, including over a million in sub-Saharan Africa. Although these numbers represent a substantial reduction from the height of the epidemic in the late 1990s, they are well off target despite intensive efforts to promote HIV combination prevention encompassing structural, behavioural and biomedical interventions. The targets were based on modelling which estimated the coverage needed to achieve these reductions, namely meeting 90-90-90 treatment targets, 90% coverage of key populations with combination prevention programmes, 90% reported condom use rates with non-regular partners and 90% male circumcision. However, investment in prevention has been lower than required to achieve this coverage , and results from trials of intensive population “test and treat” approaches show a lower impact than hoped for, with up to 30% reduction in incidence, but with lower engagement and coverage of younger people.
© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. Helen Ward1, Geoffrey P Garnett2, Kenneth H Mayer3, Gina A Dallabetta2Download PDF (38 downloads)