Controlling the HIV epidemic: A progress report on efforts in sub-Saharan Africa
In a Research Article published in PLOS Medicine, Richard Hayes of the London School of Hygiene & Tropical Medicine, UK and colleagues report early findings from PopART—a clinical trial evaluating an intervention to achieve universal HIV testing and treatment—in Zambia. The authors estimate that, after 1 y of the intervention, the proportion of people with HIV who knew their infection status had increased from 52% to 78% (men) and from 56% to 87% (women); and that the overall proportion of people with HIV receiving antiretroviral treatment (ART) had increased from 44% to 61%.
Despite progress against the HIV epidemic, some 2.1 million people were newly infected with HIV in 2015, according to the most recent estimates from UNAIDS (the joint United Nations Programme on HIV/AIDS). In that year, more than a million people died from HIV-related illnesses, mostly in low- and middle-income countries. To accelerate progress against this disastrous toll of ill health and mortality, UNAIDS has set ambitious "90-90-90" targets: by 2020, 90% of people infected with HIV should know their status, with 90% of people diagnosed with HIV infection to be receiving ART and 90% of people receiving treatment to have viral suppression. PopART and other large studies are aiming to evaluate programmes for universal testing and treatment towards these goals and to measure their effect on the number of new HIV infections.
PopART (also known as HPTN 071) is being implemented in 21 urban communities in Zambia and South Africa with a total population of around 1 million. The new paper reports findings from the first year of the study in Zambia only. In PopART, community HIV care providers systematically visit people in their homes to offer HIV testing and counselling, with linkage to appropriate facility-based care and follow-up for people with HIV, tuberculosis and other diseases. Hayes and colleagues report that, after 1 y, the estimated population proportion of those with HIV infection knowing their status was close to the UNAIDS target in women (87%); the lower proportion in men (78%) suggests that reaching men through home visits may be challenging. Although the estimated proportion of HIV-positive people on ART increased from 44% to 61%, this falls short of the 81% target (90% of 90%). The data also suggest that ART coverage was lower in younger adults with HIV. The trial is ongoing, and additional findings will be reported in future years.
Collins Iwuji and Marie-Louise Newell discuss the research in an accompanying Perspective, concluding that "Overall, these results would suggest that it is unlikely that the rather optimistic forecasts...of an imminent end to the global HIV epidemic will be fulfilled. Substantial resources are needed to further scale up ART for all HIV-positive adults, and allocation of limited resources will need to be optimised on the basis of evidence of efficacy."