Evidence with 95-95-95 that ambitious is feasible

Maheu-Giroux, Mathieu; Mishra, Sharmistha

doi:10.1016/s2352-3018(24)00028-6

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…With the expansion of HIV testing and treatment services, many countries in ESA have either attained or are close to attaining the "95-95-95" targets at a population level [12,13]. Thus, determining novel effective methods to measure HIV epidemic control and direct future efforts to accelerate epidemic decline in such contexts is required.…”

Section: Introductionmentioning

confidence: 99%

Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage

Brizzi,

Kagaayi,

Ssekubugu

et al. 2024

Preprint

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Introduction: To prioritize and tailor interventions for ending AIDS by 2030 in Africa, it is important to characterize the population groups in which HIV viraemia is concentrating. Methods: We analysed HIV testing and viral load data collected between 2013-2019 from the open, population-based Rakai Community Cohort Study (RCCS) in Uganda, to estimate HIV seroprevalence and population viral suppression over time by gender, one-year age bands and residence in inland and fishing communities. All estimates were standardized to the underlying source population using census data. We then assessed 95-95-95 targets in their ability to identify the populations in which viraemia concentrates. Results: Following the implementation of Universal Test and Treat, the proportion of individuals with viraemia decreased from 4.9% (4.6%-5.3%) in 2013 to 1.9% (1.7%-2.2%) in 2019 in inland communities and from 19.1% (18.0%-20.4%) in 2013 to 4.7% (4.0%-5.5%) in 2019 in fishing communities. Viraemia did not concentrate in the age and gender groups furthest from achieving 95-95-95 targets. Instead, in both inland and fishing communities, women aged 25-29 and men aged 30-34 were the 5-year age groups that contributed most to population-level viraemia in 2019, despite these groups being close to or had already achieved 95-95-95 targets. Conclusions: The 95-95-95 targets provide a useful benchmark for monitoring progress towards HIV epidemic control, but do not contextualize underlying population structures and so may direct interventions towards groups that represent a marginal fraction of the population with viraemia.

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Section: Introductionmentioning

confidence: 99%

Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage

Brizzi,

Kagaayi,

Ssekubugu

et al. 2024

Preprint

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HIV vaccination: Navigating the path to a transformative breakthrough—A review of current evidence

Scott,

Worku

2024

Health Science Reports

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Background and AimHuman immunodeficiency virus (HIV) remains a significant global health challenge, with approximately 39 million people living with HIV worldwide as of 2022. Despite progress in antiretroviral therapy, achieving the UNAIDS “95‐95‐95” target to end the HIV epidemic by 2025 faces challenges, particularly in sub‐Saharan Africa. The pursuit of an HIV vaccine is crucial, offering durable immunity and the potential to end the epidemic. Challenges in vaccine development include the lack of known immune correlates, suitable animal models, and HIV's high mutation rate. This study aims to explore the current state of HIV vaccine development, focusing on the challenges and innovative approaches being investigated.MethodsIn writing this review, we conducted a search of medical databases such as PubMed, ResearchGate, Web of Science, Google Scholar, and Scopus. The exploration of messenger ribonucleic acid vaccines, which have proven successful in the SARS‐CoV‐2 pandemic, presents a promising avenue for HIV vaccine development. Understanding HIV‐1's ability to infiltrate various bodily compartments, establish reservoirs, and manipulate immune responses is critical. Robust cytotoxic T lymphocytes and broadly neutralizing antibodies are identified as key components, though their production faces challenges. Innovative approaches, including computational learning and advanced drug delivery systems, are being investigated to effectively activate the immune system.Results and ConclusionsDiscrepancies between animal models and human responses have hindered the progress of vaccine development. Despite these challenges, ongoing research is focused on overcoming these obstacles through advanced methodologies and technologies. Addressing the challenges in HIV vaccine development is paramount to realizing an effective HIV‐1 vaccine and achieving the goal of ending the epidemic. The integration of innovative approaches and a deeper understanding of HIV‐1's mechanisms are essential steps toward this transformative breakthrough.

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Quantifying the impact of cascade inequalities: a modelling study on the prevention impacts of antiretroviral therapy scale-up in Eswatini

Knight,

Ma,

Sithole

et al. 2024

Preprint

Self Cite

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Background. Inequalities in the antiretroviral therapy (ART) cascade across subpopulations remain an ongoing challenge in the global HIV response. Eswatini achieved the UNAIDS 95-95-95 targets by 2020, with differentiated programs to minimize inequalities across subpopulations, including for female sex workers (FSW) and their clients. We sought to estimate additional HIV infections expected in Eswatini if cascade scale-up had not been equal, and under which epidemic conditions these inequalities could have the largest influence. Methods. Drawing on population-level and FSW-specific surveys in Eswatini, we developed a compartmental model of heterosexual HIV transmission which included eight subpopulations and four sexual partnership types. We calibrated the model to stratified HIV prevalence, incidence, and ART cascade data. Taking observed cascade scale-up in Eswatini as the base-case - reaching 95-95-95 in the overall population by 2020 - we defined four counterfactual scenarios in which the population overall reached 80-80-90 by 2020, but where FSW, clients, both, or neither were disproportionately left behind, reaching only 60-40-80. We quantified relative additional cumulative HIV infections by 2030 in counterfactual base-case scenarios. We further estimated linear effects of viral suppression gap among FSW and clients on additional infections by 2030, plus effect modification by FSW/client population sizes, rates of turnover, and HIV prevalence ratios. Findings. Compared with the base-case scenario, leaving behind neither FSW and nor their clients led to the fewest additional infections by 2030: median (95% credible interval) 13.3 (9.2, 18.7)% vs 26.7 (19.7, 33.8)% if both were left behind - a 104 (50, 167)% increase. The effect of lower cascade on additional infections was larger for clients FSW, and client population size, turnover, and prevalence ratios were the largest modifiers of both effects. Interpretation. Inequalities in the ART cascade across subpopulations can undermine the anticipated prevention impacts of cascade scale-up. As Eswatini has shown, addressing inequalities in the ART cascade, particularly those that intersect with high transmission risk, could maximize incidence reductions from cascade scale-up. Funding. Natural Sciences and Engineering Research Council of Canada; Ontario Ministry of Colleges and Universities; Canadian Institutes of Health Research; National Institute of Allergy and Infectious Diseases.

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Evidence with 95-95-95 that ambitious is feasible

Cited by 3 publications

References 6 publications

Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage

Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage

HIV vaccination: Navigating the path to a transformative breakthrough—A review of current evidence

Quantifying the impact of cascade inequalities: a modelling study on the prevention impacts of antiretroviral therapy scale-up in Eswatini

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