Vital Signs: Progress Toward Eliminating HIV as a Global Public Health Threat Through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President’s Emergency Plan for AIDS Relief — Worldwide, 2004–2022

Abstract

Introduction In 2004, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), with CDC as a major U.S. government implementing agency, began providing HIV antiretroviral therapy (ART) worldwide. Through suppression of HIV viral load, effective ART reduces morbidity and mortality among persons with HIV infection and prevents vertical and sexual transmission. Methods To describe program impact, data were analyzed from all PEPFAR programs and from six countries that have conducted nationally representative Population-based HIV Impact Assessment (PHIA) surveys, including PEPFAR programmatic data on the number of persons with HIV infection receiving PEPFAR-supported ART (2004–2022), rates of viral load coverage (the proportion of eligible persons with HIV infection who received a viral load test) and viral load suppression (proportion of persons who received a viral load test with <1,000 HIV copies per mL of blood) (2015–2022), and population viral load suppression rates in six countries that had two PHIA surveys conducted during 2015–2021. To assess health system strengthening, data on workforce and laboratory systems were analyzed. Results By September 2022, approximately 20 million persons with HIV infection in 54 countries were receiving PEPFAR-supported ART (62% CDC-supported); this number increased 300-fold from the 66,550 reported in September 2004. During 2015–2022, viral load coverage more than tripled, from 24% to 80%, and viral load suppression increased from 80% to 95%. Despite increases in viral load suppression rates and health system strengthening investments, variability exists in viral load coverage among some subpopulations (children aged <10 years, males, pregnant women, men who have sex with men [MSM], persons in prisons and other closed settings [persons in prisons], and transgender persons) and in viral load suppression among other subpopulations (pregnant and breastfeeding women, persons in prisons, and persons aged <20 years). Conclusions and implications for public health practice Since 2004, PEPFAR has scaled up effective ART to approximately 20 million persons with HIV infection in 54 countries. To eliminate HIV as a global public health threat, achievements must be sustained and expanded to reach all subpopulations. CDC and PEPFAR remain committed to tackling HIV while strengthening public health systems and global health security.

Risk of transmission of HIV to infants during breast/chest feeding when mothers/birthing parents living with HIV are on antiretroviral therapy: a protocol for a rapid review

“…We will systematically search Medline (via Ovid), Embase (via Ovid) and Global Health (via Ovid) for systematic reviews and peer-reviewed articles from 1 January 2005 to 1 November 2023. This is consistent with the work of previous systematic reviews who restricted the selection of studies from 2005 or later because triple combination ART regimens were introduced in public health programmes in 2004 30 31. Search types and patterns are featured in online supplemental appendix 2.…”

Comparison of HIV prevalence, incidence, and viral load suppression in Zambia population-based HIV impact assessments from 2016 and 2021

“…Zambia's progress in controlling HIV is in-line with other countries in Africa experiencing generalized HIV epidemics [25][26][27][28][29]. VLS prevalence significantly increased across demographic variables and, notably, in some groups it is very high.…”

Accelerating and sustaining progress: PEPFAR’s path to achieving 95-95-95 by 2030

“…Over the past two decades, the President’s Emergency Plan for AIDS Relief (PEPFAR) has played a pivotal role in catalysing an unprecedented scale-up of HIV services, yielding remarkable dividends. Thanks to PEPFAR, about 5.5 million children have been born HIV-free,1 25 million lives saved, and over 20 million people are on life-saving treatment across 54 countries 2. Countries like Botswana, Eswatini, Rwanda and Zimbabwe, which have suffered under a terrible burden of HIV disease for the last two decades, are seeing remarkable declines in HIV incidence and AIDS-related deaths 3.…”

“…Thanks to PEPFAR, about 5.5 million children have been born HIV-free, 1 25 million lives saved, and over 20 million people are on life-saving treatment across 54 countries. 2 Countries like Botswana, Eswatini, Rwanda and Zimbabwe, which have suffered under a terrible burden of HIV disease for the last two decades, are seeing remarkable declines in HIV incidence and AIDS-related deaths. 3 However, the UNAIDS goal of achieving 95% diagnosis, treatment and viral suppression rates by 2030 is less secure in certain countries and specific populations, and concerted collective action is necessary to end the epidemic globally.…”