What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach

Abstract

In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually—far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US$7.4Bn in low-income countries, US$8.2Bn in lower middle-income countries and US$10.5Bn in upper-middle-income-countries by 2020 before declining approximately 9% by 2030.

High HIV Prevalence and Risk Among Male Clients of Female Sex Workers in Hanoi and Ho Chi Minh City, Vietnam

“…Examples of such innovation may include: community-based HIV counseling and testing (e.g., offering such services in or near locations frequented by male clients, self-testing) and incentivizing testing and linkage to antiretroviral treatment. In addition, Vietnam should also continue to expand its evidence-based harm reduction programs for drug use including methadone maintenance treatment [23, 24], needle/syringe exchange, and annual HIV counseling and testing and immediate anti-retroviral therapy (ART) for HIV-infected injection drug users [25–27]. Conversely, FSWs should have access to key services such as HIV testing and linkage to care as well as be empowered to demand consistent condom use by their male clients.…”

Patient perspectives on de‐simplifying their single‐tablet co‐formulated antiretroviral therapy for societal cost savings

“…The goals of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90‐90‐90 targets are both laudable and achievable, but the full and successful implementation of such programmes in high‐income countries will be expensive . As more individuals living with HIV initiate antiretroviral therapy (ART) at higher CD4 counts, and then remain on lifelong ART, the costs of providing antiretroviral (ARV) drugs for both private and government health plans have increased substantially.…”

Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013

“…To ensure effective implementation of prompt access to treatment and other prevention interventions, it is essential to have estimates of HIV incidence for describing the current dynamics of the epidemic [2,3]. Trends in HIV incidence indicate the degree to which HIV transmission is controlled [4], which groups are most at risk for HIV infection and help to identify the emergence of new sub-epidemics in the general population [5].…”