Katrina F Ortblad1, Jared M Baeten1,2,3, Peter Cherutich4, Joyce Njeri Wamicwe4, Judith N Wasserheit1,2,3,5. 1. Department of Global Health. 2. Department of Medicine. 3. Department of Epidemiology, University of Washington, Seattle, Washington, USA. 4. Kenya Ministry of Health, Nairobi, Kenya. 5. Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA.
Abstract
PURPOSE OF REVIEW: The aim of this review is to examine the emerging results from the HIV universal test and treat (UTT) cluster-randomized trials in sub-Saharan Africa, discuss how expanding access to HIV clinical services is likely to reshape the arc of HIV epidemics, and consider implications for HIV prevention and control strategies in the coming decade. RECENT FINDINGS: The effect of universal HIV testing followed by immediate antiretroviral treatment (ART) on community-level HIV incidence remains unclear upon completion of five randomized trials. Only two of the four trials that measured HIV incidence found significant reductions in community-level incidence. Even in these trials, HIV incidence remained above levels required for epidemic control (≤1 case per 1000 person-years) despite high levels of ART coverage and viral suppression. These findings may indicate that community-delivered HIV services are not reaching the high-frequency transmitters who sustain HIV epidemics and are likely members of marginalized or hard to engage core groups. SUMMARY: With expanded access to HIV services in sub-Saharan Africa, HIV epidemics are transitioning from hyperendemic to declining/endemic epidemic phases, characterized increasingly by the reconcentration of HIV in marginalized or hard to engage core groups. To move toward epidemic control, novel HIV service delivery models and technologies are needed to engage those who continue to drive HIV incidence in this new epidemic phase.
PURPOSE OF REVIEW: The aim of this review is to examine the emerging results from the HIV universal test and treat (UTT) cluster-randomized trials in sub-Saharan Africa, discuss how expanding access to HIV clinical services is likely to reshape the arc of HIV epidemics, and consider implications for HIV prevention and control strategies in the coming decade. RECENT FINDINGS: The effect of universal HIV testing followed by immediate antiretroviral treatment (ART) on community-level HIV incidence remains unclear upon completion of five randomized trials. Only two of the four trials that measured HIV incidence found significant reductions in community-level incidence. Even in these trials, HIV incidence remained above levels required for epidemic control (≤1 case per 1000 person-years) despite high levels of ART coverage and viral suppression. These findings may indicate that community-delivered HIV services are not reaching the high-frequency transmitters who sustain HIV epidemics and are likely members of marginalized or hard to engage core groups. SUMMARY: With expanded access to HIV services in sub-Saharan Africa, HIV epidemics are transitioning from hyperendemic to declining/endemic epidemic phases, characterized increasingly by the reconcentration of HIV in marginalized or hard to engage core groups. To move toward epidemic control, novel HIV service delivery models and technologies are needed to engage those who continue to drive HIV incidence in this new epidemic phase.
Authors: Alison P Galvani; Abhishek Pandey; Meagan C Fitzpatrick; Jan Medlock; Glenda E Gray Journal: Lancet HIV Date: 2018-10-09 Impact factor: 12.767
Authors: Maya Petersen; Laura Balzer; Dalsone Kwarsiima; Norton Sang; Gabriel Chamie; James Ayieko; Jane Kabami; Asiphas Owaraganise; Teri Liegler; Florence Mwangwa; Kevin Kadede; Vivek Jain; Albert Plenty; Lillian Brown; Geoff Lavoy; Joshua Schwab; Douglas Black; Mark van der Laan; Elizabeth A Bukusi; Craig R Cohen; Tamara D Clark; Edwin Charlebois; Moses Kamya; Diane Havlir Journal: JAMA Date: 2017-06-06 Impact factor: 56.272
Authors: Barrot H Lambdin; Ben Cheng; Trevor Peter; Jessie Mbwambo; Tsitsi Apollo; Megan Dunbar; Ifeoma C Udoh; Adithya Cattamanchi; Elvin H Geng; Paul Volberding Journal: Curr HIV Res Date: 2015 Impact factor: 1.581
Authors: Kara K Wools-Kaloustian; John E Sidle; Henry M Selke; Rajesh Vedanthan; Emmanuel K Kemboi; Lillian J Boit; Viola T Jebet; Aaron E Carroll; William M Tierney; Sylvester Kimaiyo Journal: J Int AIDS Soc Date: 2009-09-29 Impact factor: 5.396
Authors: Myron S Cohen; M Kumi Smith; Kathryn E Muessig; Timothy B Hallett; Kimberly A Powers; Angela D Kashuba Journal: Lancet Date: 2013-10-23 Impact factor: 79.321
Authors: Lario Viljoen; Tila Mainga; Rozanne Casper; Constance Mubekapi-Musadaidzwa; Dillon T Wademan; Virginia A Bond; Triantafyllos Pliakas; Chiti Bwalya; Anne Stangl; Mwelwa Phiri; Blia Yang; Kwame Shanaube; Peter Bock; Sarah Fidler; Richard Hayes; Helen Ayles; James R Hargreaves; Graeme Hoddinott; J Seeley; D Donnell; S Floyd; N Mandla; J Bwalya; K Sabapathy; S H Eshleman; D Macleod; A Moore; S H Vermund; K Hauck; K Shanaube Journal: Health Policy Plan Date: 2021-06-25 Impact factor: 3.344
Authors: Timothy Mm Farley; Julia Samuelson; M Kate Grabowski; Wole Ameyan; Ronald H Gray; Rachel Baggaley Journal: J Int AIDS Soc Date: 2020-06 Impact factor: 5.396
Authors: Keletso Makofane; Elise M van der Elst; Jeffrey Walimbwa; Steave Nemande; Stefan D Baral Journal: J Int AIDS Soc Date: 2020-10 Impact factor: 5.396
Authors: Emmanuel Peprah; Mari Armstrong-Hough; Stephanie H Cook; Barbara Mukasa; Jacquelyn Y Taylor; Huichun Xu; Linda Chang; Joyce Gyamfi; Nessa Ryan; Temitope Ojo; Anya Snyder; Juliet Iwelunmor; Oliver Ezechi; Conrad Iyegbe; Paul O'Reilly; Andre Pascal Kengne Journal: Int J Environ Res Public Health Date: 2021-03-18 Impact factor: 3.390