Integrating and Interpreting Findings from the Latest Treatment as Prevention Trials
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TREATMENT AS PREVENTION (E GENG, SECTION EDITOR)
Integrating and Interpreting Findings from the Latest Treatment as Prevention Trials Marie A. Brault 1 & Donna Spiegelman 2 & Salim S. Abdool Karim 3 & Sten H. Vermund 4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review In 2018–2019, studies were published assessing the effectiveness of reducing HIV incidence by expanding HIV testing, linkage to HIV treatment, and assistance to persons living with HIV to adhere to their medications (the “90-90-90” strategy). These tests of “treatment as prevention” (TasP) had complex results. Recent Findings The TasP/ANRS 12249 study in South Africa, the SEARCH study in Kenya and Uganda, and one comparison (arms A to C) of the HPTN 071 (PopART) study in South Africa and Zambia did not demonstrate a community impact on HIV incidence. In contrast, the Botswana Ya Tsie study and the second comparison (arms B to C) of PopART indicated significant ≈ 30% reductions in HIV incidence in the intervention communities where TasP was expanded. Summary We discuss the results of these trials and outline future research and challenges. These include the efficient expansion of widespread HIV testing, better linkage to care, and viral suppression among all persons living with HIV. A top implementation science priority for the next decade is to determine what strategies to use in specific local contexts. Keywords HIV . Treatment as prevention . 90-90-90 targets . HIV care continuum . Implementation science . Sub-Saharan Africa
Introduction The “90-90-90” goals of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) aspire for 90% of all people living with HIV to know their status, 90% of all HIV-infected persons who know their status to take antiretroviral therapy (ART), and 90% of those on ART to be virally suppressed, all by the year 2020 [1]. None of these goals will be reached, though global progress is impressive. The goal for the year 2030 is “95-95-95.” Reflecting definitive evidence from the HIV prevention and treatment fields, global recommendations from the WHO
shifted in 2016 to urge universal treatment for all people living with HIV (PLHIV), regardless of their CD4+ cell counts or their clinical status [1–3]. These recommendations represented a more aggressive and simplified approach to ART initiation and coverage. They were based on recognition that early treatment yielded better clinical outcomes and would prevent transmissions to others (“Treatment as Prevention” [TasP]). Fiscal support to achieve 90-90-90 has come from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), National Ministries of Health, and other funding sources from donor countries and foundations. By far, this is
This article is part of the Topical Collection on Treatment as Prevention * Marie A. Brault [email protected]
1
Department of Social and Behavioral Sciences, Yale School of Public Hea
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