Biology subjects

Granich, R.

Publications and source records attributed to Granich, R..

5 recordsLinked to original sources

bioRxiv2018

Ending AIDS: trends in the incidence of HIV in eastern and southern Africa

While great progress has been made in the control and management of the HIV epidemic there is still much to be done. Using trends in the rate of new HIV infections in eastern and southern Africa we assess the current state of the epidemic and evaluate the future prospects for controlling it. If we let an incidence of 1 per 1,000 people represent a control threshold then this has been reached, or will probably be reached by 2020, in eastern Africa and is reachable by 2020 in those southern African countries that do not have particularly strong social and economic ties to South Africa if they continue to scale up their treatment programmes. In South Africa and its immediate neighbours Lesotho, Mozambique and Swaziland, the prospects are less certain. These countries are unlikely to reach the control threshold by 2020 but with sufficient political will and commitment to treatment for all could do so by 2030.\n\nThere are two important caveats. First, reaching the control threshold still leaves 35 thousand new infections a year. As the lessons of polio remind us, finding the last few, hard to reach cases will demand more focussed strategies. Second, ending AIDS will not end HIV and about 35 million people will have to be kept on ART for the next 30 to 40 years unless and until a cure is discovered. Even if we assume a modest cost of, say, US$100 per person per year for ART treatment and support, this corresponds to a continuing financial commitment of US$3.5 Bn per year although this is substantially less than the approximately US$ 40 Bn per year currently committed to HIV and AIDS.

epidemiology↗

bioRxiv2017

Antiretroviral treatment, prevention of transmission, and modeling the HIV epidemic: why the ART efficacy, coverage, and effectiveness parameters matter

IntroductionHIV remains a major public health threat with over 75 million deaths, 2 million annual infections and over 1 million HIV-associated TB cases a year. Population-based studies suggest a marked decline in incidence, prevalence and deaths, mostly likely due to treatment expansion, in countries in East and Southern Africa. This calls into question the ART efficacy, effectiveness and coverage parameters used by many modelers to project HIV incidence and prevalence.\n\nMethodsFor 2015 and 2016 we reviewed global and national mathematical modeling studies regarding ART impact (with or without other HIV prevention interventions) and/or 90-90-90 on either new HIV infections or investment or both. We reviewed these HIV epidemiologic and costing models for their structure and parameterization around ART; we directly compared two models to illustrate differences in outcome.\n\nResultsThe nine models published in 2015 or 2016 included parameters for ART effectiveness ranging from 20% to 86% for ART effectiveness. Model 1 limits eligibility for ART initiation to 80% coverage of people living with HIV and with a CD4+ cell count below 350 cells/L, 70% retention, and ART reduces transmission by 80%, with a derived ART effectiveness of 20%. Model 2 assumes 90-90-90 by 2020 (i.e., 73% viral suppression of estimated PLHIV), ART reduces transmission by 96% in those on ART and virally suppressed, and by 88% in those on ART but not virally suppressed with a derived effectiveness of 86% and consequent decline towards ending AIDS and HIV elimination. ART parameter selection and assumptions dominate and low ART effectiveness translates into lower impact.\n\nDiscussionUsing more realistic parameters for ART effectiveness suggests that through expanding access and supporting sustainable viral suppression it will be possible to significantly reduce transmission and eliminate HIV in many settings.

epidemiology↗

bioRxiv2017

90-90-90, epidemic control, and ending AIDS: review of global situation and recommendations

HIV remains a devastating pandemic HIV remains a devastating... Ending AIDS The prevention vs. treatment... Economics of ending AIDS Major innovations accelerating... HIV self-tests Universal treatment regimen Comprehensive community-based... Standardized M and E... Unification of global leadership... Last mile strategies,... Conclusion References Although human immunodeficiency virus (HIV) first came to our attention thirty-seven years ago, the acquired immunodeficiency syndrome (AIDS) which it causes is, without treatment, 100% fatal with devastating consequences for millions of people1. More than 35 million people have already died of ...

epidemiology↗

bioRxiv2017

Two diseases, same person: moving towards a combined HIV and TB continuum of care

SettingThe Human Immunodeficiency Virus (HIV) and Mycobacterium tuberculosis syndemic remains a global public health threat. Separate HIV and TB global targets have been set, however, success will depend on achieving combined disease control objectives and care continua.\n\nObjectiveReview available policy, budgets and data to re-conceptualize TB and HIV disease control objectives by combining HIV and TB care continua.\n\nMethodsFor 22 WHO TB and TB/HIV priority countries, we used 2014 and 2015 data from the HIV90-90-90watch website, UNAIDS Aidsinfo, and WHO 2016 Global TB Report. Global resources available in TB and HIV/TB activities for 2003-2017 was collected from publically available sources.\n\nResultsIn 22 high burden countries people living with HIV (PLHIV) on ART ranged from 9-70%; viral suppression was 38-63%. TB treatment success ranged from 34-94% with 13 (43% HIV/TB burden) countries above 80% TB treatment success. From 2003-2017, global international and domestic resources for HIV-associated TB and TB averaged $2.6 billion per year; the total for 2003-2017 was 39 billion dollars.\n\nConclusionReviewing combined HIV and TB targets demonstrate disease control progress and challenges. Using an integrated HIV and TB continuum supports HIV and TB disease control efforts focused on improving both individual and public health.\n\nFundingNone

epidemiology↗

bioRxiv2017

Review of UNAIDS national estimates of men who have sex with men, gay dating application users, and HIV 90-90-90 data

BackgroundAchieving the 90-90-90 is essential to keep people alive and to end AIDS. Men who have sex with men (MSM) often have the least access to HIV services.\n\nPurposeEstimates for key populations are often unavailable, dated or have very wide confidence intervals and more accurate estimates are required.\n\nMethodsWe compared registered users from a major gay dating application (2016) from 29 countries with the latest available (2013-2016) UNAIDS estimates by country. We searched the Internet, PubMed, national surveillance reports, UNAIDS country reports, Presidents Emergency Plan for AIDS Relief (PEPFAR) 2016 and 2017 operational plans, and conference abstracts for the latest nationally representative continua for MSM.\n\nResultsOf comparison countries, only 18 countries had UNAIDS or other MSM population estimates in the public domain. UNAIDS estimates were larger than the gay dating application users in 9 countries, perhaps reflecting incomplete market penetration for the application. The gay dating application users in 9 countries were above the UNAIDS estimates; 8 were over 30% higher and three more than double the reported estimate. Seven partial or complete nationally representative care continua for MSM were published between 2010 and 2016. Among estimated MSM living with HIV, viral suppression varied between 42% (United States) to 99% (Denmark). The quality of the continua methods varied (quality data not shown).\n\nConclusion\"What is not monitored is not done\" and social media has significant promise to improve estimates to ensure that MSM and other vulnerable people living with HIV and their communities are not left behind on the way to ending AIDS.

epidemiology↗