Fast-Track Cities: striving to end urban HIV epidemics by 2030.

BackgroundThe Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track initiative seeks to eliminate AIDS as a health threat by 2030, with its focus on UNAIDS 90-90-90 targets. Effective policies and programs, if scaled nationally, have the potential to generate a greater impact on HIV control, yet a synthesis of successful HIV policies/programs aligned to the targets is currently unavailable. To fill this gap, we conducted a systematic review to evaluate successful HIV policies and programs to direct future interventions.MethodsFor the period 2007–2018, we searched 8 databases and classified eligible studies by country income level, UNAIDS targets, intervention type, and reported outcomes. Study outcomes were classified as per UNAIDS targets; proportionally: 90% target 1, 81% target 2, and 73% target 3.ResultsWe retrieved 5201 citations and a final set of eight studies on policies. Break up by income: three (38%) from high income, one (12%) from middle income and four (50%) from low income. Break up by outcomes reported: 36% (4/11) focused on HIV testing, 46% (5/11) on antiretroviral therapy initiation, and 18% (2/11) on viral suppression. Across studies, UNAIDS targets were met in high-income countries, where policies and guidelines were adhered to, whereas in low and middle-income countries, non-adherence led to failure to reach the targets. Targets were also met when country infrastructure supported a targeted program and stakeholders were actively engaged.ConclusionsFrom the studies identified, we deduced a clear, positive correlation between implementation of policies and programs that resulted in an increase in patient awareness and an increase in partner notification with services that encouraged them, and together these resulted in increasing testing rates, and deployment of linkage/retention programs that improved retention in care. An analysis of these studies also suggests that policies, combined with the scale-up incentives, are needed to change the status quo. Incentives to improve the targets must exist; performance incentives at the health care worker level and country level incentives that could transform the nature of care. Given the complexity in reporting of targets, a one size fits all model is not a feasible option. However, the policies created a strong framework to shape future interventions.

The usefulness of HIV partner services in the age of treatment as prevention: a registry-based study

BackgroundIn 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for human immunodeficiency virus (HIV). The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Consistent methods and routine reporting in the public domain will be necessary for tracking progress towards the 90-90-90 target.Methods and findingsFor the period 2010–2016, we searched PubMed, UNAIDS country progress reports, World Health Organization (WHO), UNAIDS reports, national surveillance and program reports, United States President’s Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans, and conference presentations and/or abstracts for the latest available national HIV care continuum in the public domain. Continua of care included the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed out of the estimated number of PLHIV. We ranked the described methods for indicators to derive high-, medium-, and low-quality continuum. For 2010–2016, we identified 53 national care continua with viral suppression estimates representing 19.7 million (54%) of the 2015 global estimate of PLHIV. Of the 53, 6 (with 2% of global burden) were high quality, using standard surveillance methods to derive an overall denominator and program data from national cohorts for estimating steps in the continuum. Only nine countries in sub-Saharan Africa had care continua with viral suppression estimates. Of the 53 countries, the average proportion of the aggregate of PLHIV from all countries on ART was 48%, and the proportion of PLHIV who were virally suppressed was 40%. Seven countries (Sweden, Cambodia, United Kingdom, Switzerland, Denmark, Rwanda, and Namibia) were within 12% and 10% of achieving the 90-90-90 target for “on ART” and for “viral suppression,” respectively. The limitations to consider when interpreting the results include significant variation in methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain.ConclusionsRelatively few complete national continua of care are available in the public domain, and there is considerable variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency.

The experience of patients living with human-immunodeficiency virus/tuberculosis co-infection: a systematic review of qualitative evidence protocol

Mean Age of First Sex: Do They Know What We Mean?

BackgroundHigh uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region.MethodsA CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit.ResultsWe estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries.ConclusionsThe EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control.

Control of the pediatric HIV epidemic is hampered by gaps in diagnosis and linkage to effective treatment. The 2015-2016 Malawi Population-based HIV impact assessment data were analyzed to identify gaps in pediatric HIV diagnosis, treatment, and viral load suppression. In half of the surveyed households, children ages ≥18 months to <15 years were tested using the national HIV rapid test algorithm. Children ≤18 months reactive by the initial rapid test underwent HIV total nucleic acid polymerase chain reaction confirmatory testing. Blood from HIV-positive children was tested for viral load (VL) and presence of antiretroviral drugs. HIV diagnosis and antiretroviral treatment (ART) use were defined using guardian-reporting or antiretroviral detection. Of the 6166 children tested, 99 were HIV-positive for a prevalence of 1.5% (95% confidence intervals [CI]: 1.1-1.9) and 8.0% (95% CI: 5.6-10.5) among HIV-exposed children. The prevalence of 1.5% was extrapolated to a national estimate of 119,501 (95% CI: 89,028-149,974) children living with HIV (CLHIV), of whom, 30.7% (95% CI: 20.3-41.1) were previously undiagnosed. Of the 69.3% diagnosed CLHIV, 86.1% (95% CI: 76.8-95.6) were on ART and 57.9% (95% CI: 41.4-74.4) of those on ART had suppressed VL (<1000 HIV RNA copies/mL). Among all CLHIV, irrespective of HIV diagnosis or ART use, 57.7% (95% CI: 45.0-70.5) had unsuppressed VL. Critical gaps in HIV diagnosis in children persist in Malawi. The large proportion of CLHIV with unsuppressed VL reflects gaps in diagnosis and need for more effective first- and second-line ART regimens and adherence interventions.

Access to care.

According to Joint United Nations Programme on HIV/AIDS (UNAIDS) data, 36.9 million people are living with HIV worldwide. Older adults, those aged 50 years and older, with HIV are increasing worldwide; however, the prevalence and incidence differ substantially across regions. The purpose of this article is to provide an overview of how HIV is impacting older adults globally, with a focus on sexual and gender minority older adults. The article is organized using the eight geographical regions from UNAIDS, with information on the prevalence and incidence among older adults. Among sexual and gender minority older adults, key risks are identified, including laws that criminalize same-sex relationships; issues of stigma and fear; and the concomitant lack of access and barriers to HIV testing, treatment, and prevention. Progress within each region toward the UNAIDS 90-90-90 targets is included, and suggestions for future directions of research and service delivery are made.

World AIDS Day 2022: A bittersweet commemoration of the global HIV/AIDS response.

This chapter describes the evolution of the Joint United Nations Programme on HIV/AIDS (UNAIDS). At a time when the discovery of Highly Active Antiretroviral Therapy (HAART) had energized the AIDS community, UNAIDS faced significant difficulty trying to establish its leadership amongst shrinking budgets, quarrelling cosponsors, inconsistent and inadequate support from donors, and a strained relationship with the World Health Organization. UNAIDS established UN theme groups on HIV/AIDS to provide a single UN voice on AIDS policies in countries, strove to improve access to HAART, especially in low- and middle-income countries, and built relationships with nontraditional partners, particularly non-governmental organizations, faith-based organizations, and the business community. Against this back drop, the AIDS world lost one of its greatest champions when Jonathan Mann tragically died in a commercial plane crash.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set the global goal of ending the AIDS world epidemic by 2030. In order to end this epidemic they have established a 90-90-90 goal to be achieved by 2020, which may be problematic, especially in low- and middle-income countries. This goal includes 90% of individuals with HIV globally being diagnosed, on treatment, and virologically suppressed. Based on global estimates from 2014–2015, approximately 36.9 million individuals are living with HIV. Of those, 53% have been diagnosed with HIV, 41% are on antiretroviral therapy (ART), and 32% have viral suppression with <1000 copies/ml. Comprehensive approaches are needed to improve the number of people living with HIV (PLWH) who are diagnosed, linked, and engaged in care. Once PLWH are retained in care, treatment is key to both HIV prevention and transmission. The development and advancement of new ART is necessary to assist in reaching these goals by improving safety profiles, decreasing pill burden, improving quality of life and life expectancy, and creating new mechanisms to overcome resistance. The focus of this review is to highlight and review data for antiretroviral agents recently added to the market as well as discuss agents in various stages of development (new formulations and mechanisms of action).

Digital health technologies are revolutionizing healthcare delivery in Africa and across the globe. However, their impact on improving care for people living with HIV (PLHIV) in Africa has been relatively unexplored. The UNAIDS 95:95:95 targets face stark drawbacks from poor adherence to antiretroviral therapy (ART) and retention in care. Although digital tools have strengthened the HIV care cascade, particularly at the critical stages of initiation, adherence, and retention, their impact and synergistic potential remain uncertain. This review synthesized African evidence to assess the roles and impact of digital monitoring tools for improving ART adherence and retention among PLHIV in Africa. In addition, it summarizes potential facilitators and barriers to integrating these tools into the HIV care continuum in Africa. A literature search was conducted using PubMed, Google Scholar, Embase, and Cochrane Central. The websites of the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) were also searched for additional data. The searches were restricted to studies published in English from January 2010 to November 2023. The review identified a significant trend towards utilizing mobile phones, SMS, and web-based applications for ART adherence and retention monitoring in Africa, where the use of mobile devices for periodic reminders and remote counseling has boosted HIV adherence in Nigeria, South Africa, and Uganda to about 75%. Novel interventions encompassing electronic pharmacy refill tracking, tele-counseling, and medication electronic monitoring systems such as smart pill containers have been utilized but with sparse usage. These tools have been invaluable in overcoming the barriers to antiretroviral adherence and retention, such as stigma, the digital divide, privacy concerns, and limited healthcare access. Collaboration between key stakeholders like local health professionals and multinationals is crucial to overcoming these barriers. Furthermore, exploring other potential facilitators, such as tailored intervention and community engagement, is vital for maximizing the impact of these technologies.

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.

Programmatic treatment outcome data for people living with human immunodeficiency virus type 2 (HIV-2) in West Africa, where the virus is most prevalent, are scarce. Adults with HIV-2 initiating or receiving antiretroviral therapy (ART) through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 cell counts, antiretroviral drug resistance, loss to follow-up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV-2. We enrolled 291 participants at 2 sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression (< 50 copies/mL) at enrollment increased over calendar time. Over the study period, 76.7% of plasma viral loads for participants receiving ART were suppressed, and median CD4 gain was 84 cells/μL in participants' first 2 years on study. Since the UNAIDS 90-90-90 strategy was published, 88.1% of viral loads were suppressed. Fifteen percent of patients experienced virologic failure with no known resistance mutations, while 56% had evidence of multiclass drug resistance. Participants in the Senegalese national AIDS program are initiating ART earlier in the course of disease, and more modern therapeutic regimens have improved outcomes among those receiving therapy. Despite these achievements, HIV-2 treatment remains suboptimal, and significant challenges to improving care remain.