Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission

Bekker, Linda‐Gail; Alleyne, George A.O.; Baral, Stefan; Cepeda, Javier; Daskalakis, Demetre; Dowdy, David W.; Dybul, Mark; Eholié, Serge; Esom, Kene; Garnett, Geoff P.; Grimsrud, Anna; Hakim, James; Havlir, Diane V.; Isbell, Michael T.; Johnson, Leigh F.; Kamarulzaman, Adeeba; Kasaie, Parastu; Kazatchkine, Michel D.; Kilonzo, Nduku; Klag, Michael J.; Klein, Marina B.; Lewin, Sharon R.; Luo, Chewe; Makofane, Keletso; Martin, Natasha K.; Mayer, Kenneth H.; Millett, Gregorio A.; Ntusi, Ntobeko; Pace, Loyce; Pike, Carey; Piot, Peter; Pozniak, Anton; Quinn, Thomas C.; Rockstroh, Jürgen K.; Ratevosian, Jirair; Ryan, Owen; Sippel, Serra; Spire, Bruno; Soucat, Agnès; Starrs, Ann; Strathdee, Steffanie A.; Thomson, Nicholas; Vella, Stefano; Schechter, Mauro; Vickerman, Peter; Weir, Brian W.; Beyrer, Chris

doi:10.1016/s0140-6736(18)31070-5

Cited by 250 publications

(208 citation statements)

References 159 publications

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“…It is important to recognize that while continued efforts in testing are likely to reduce the number of people with undiagnosed HIV, the proportion of these people that are hard to reach is likely to increase and hence increased resources may be required for outreach testing to maintain current testing rates. Furthermore, while continued efforts are needed to diagnose and treat those with HIV, resources also need to be used to maximize prevention of HIV 27, provided that the use of such resources is cost‐effective.…”

Section: Discussionmentioning

confidence: 99%

90‐90‐90 by 2020? Estimation and projection of the adult HIV epidemic and ART programme in Zimbabwe – 2017 to 2020

Bansi‐Matharu¹,

Cambiano²,

Apollo

et al. 2018

J Intern AIDS Soc

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IntroductionThe 90‐90‐90 targets set by the United Nations aspire to 73% of people living with HIV (PLHIV) being virally suppressed by 2020. Using the HIV Synthesis Model, we aim to mimic the epidemic in Zimbabwe and make projections to assess whether Zimbabwe is on track to meet the 90‐90‐90 targets and assess whether recently proposed UNAIDS HIV transition metrics are likely to be met.MethodsWe used an approximate Bayesian computation approach to identify model parameter values which result in model outputs consistent with observed data, evaluated using a calibration score. These parameter values were then used to make projections to 2020 to compare with the 90‐90‐90 targets and other key indicators. We also calculated HIV transition metrics proposed by UNAIDS (percentage reduction in new HIV infections and AIDS‐related mortality from 2010 to 2020, absolute rate of new infections and AIDS‐related mortality, incidence–mortality ratio and incidence–prevalence ratios).ResultsAfter calibration, there was general agreement between modelled and observed data. The median predicted outcomes in 2020 were: proportion of PLHIV (aged 15 to 65) diagnosed 0.91 (90% uncertainty range 0.87, 0.94) (0.84 men, 0.95 women); of those diagnosed, proportion on treatment 0.92 (0.90, 0.93); of those receiving treatment, proportion with viral suppression 0.86 (0.81, 0.91). This results in 72% of PLHIV having viral suppression in 2020. We estimated a percentage reduction of 36.5% (13.7% increase to 67.4% reduction) in new infections from 2010 to 2020, and of 30.4% (9.7% increase to 56.6% reduction) in AIDS‐related mortality (UNAIDS target 75%). The modelled absolute rates of HIV incidence and AIDS‐related mortality in 2020 were 5.48 (2.26, 9.24) and 1.93 (1.31, 2.71) per 1000 person‐years respectively. The modelled incidence–mortality ratio and incidence–prevalence ratios in 2020 were 1.05 (0.46, 1.66) and 0.009 (0.004, 0.013) respectively.ConclusionsOur model was able to produce outputs that are simultaneously consistent with an array of observed data and predicted that while the 90‐90‐90 targets are within reach in Zimbabwe, increased efforts are required in diagnosing men in particular. Calculation of the HIV transition metrics suggest increased efforts are needed to bring the HIV epidemic under control.

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Section: Discussionmentioning

confidence: 99%

90‐90‐90 by 2020? Estimation and projection of the adult HIV epidemic and ART programme in Zimbabwe – 2017 to 2020

Bansi‐Matharu¹,

Cambiano²,

Apollo

et al. 2018

J Intern AIDS Soc

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“…sub-Saharan African health systems face numerous challenges, including critical health workforce shortages, fragmented health services and mismatched funding/ resource allocation which hampers their capacity to serve this growing patient population (Atun et al, 2013;Criel, Kegels, Stuyft, & d., 2004). Whilst chronic care services are still in a developmental phase in most parts of Africa, there is evidence of local innovation and experimentation, which slowly diffuse into health service delivery structures (Aantjes, Quinlan, & Bunders, 2014;Bekker et al, 2018). Most examples stem from HIV-focused services, whereby non-clinical staff and lay caregivers are drawn into the provision of self-management support (Levitt, Steyn, Dave, & Bradshaw, 2011;Rabkin & El-Sadr, 2011).…”

Section: Introductionmentioning

confidence: 99%

Patient–provider perspectives on self‐management support and patient empowerment in chronic care: A mixed‐methods study in a rural sub‐Saharan setting

Aantjes

Bunders

Lazarus

et al. 2019

Journal of Advanced Nursing

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AimTo explore how provision of self‐management support to chronically‐ill patients in resource‐limited settings contributes to patient empowerment in chronic care.DesignConcurrent descriptive mixed methods research.MethodsA survey of 140 patients with chronic conditions administered at four time‐points in 12 months. We conducted 14 interviews and four focus‐group discussions with patients (N = 31); 13 healthcare provider interviews; and observations of four patient‐support group meetings. Data were collected between April 2016 ‐ May 2017 in rural Malawi. Qualitative data were analysed using a thematic approach and descriptive statistical analysis performed on survey data.ResultsHealthcare professionals facilitated patient empowerment through health education, although literacy levels and environmental factors affected self‐management guidance. Information exchanged during patient–provider interactions varied and discussions centred around medical aspects and health promoting behaviour. Less than 40% of survey patients prepared questions prior to clinic consultations. Health education was often unstructured and delegated to non‐physician providers, mostly untrained in chronic care. Patients accessed psychosocial support from volunteer‐led community home‐based care programmes. HIV support‐groups regularly interacted with peers and practical skills exchanged in a supportive environment, reinforcing patient's self‐mangement competence and proactiveness in health care.ConclusionFor optimal self‐management, reforms at inter‐personal and organizational level are needed including; mutual patient‐provider collaboration, diversifying access to self‐management support resources and restructuring patient support‐groups to cater to diverse chronic conditions.ImpactOur study provides insights and framing of self‐management support and empowerment for patients in long‐term care in sub‐Saharan Africa. Lessons drawn could feed into designing and delivering responsive chronic care interventions.

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“…As such, the world is at a critical juncture in the HIV response. Decelerating the response now would reverse the enormous gains achieved so far .…”

mentioning

confidence: 99%

“…Ensuring that there is a fully funded response with efficient utilization of domestic and external resources is fundamental . We would suggest four other critical elements: (a) adapting services based on community involvement and demand, so, called human‐centred design; (b) “taking AIDS out of isolation” by addressing the wider determinants of health and social wellbeing including gender norms, stigma and the economic costs of accessing health services, including user fees ; (c) using data to identify and map where most infections are occurring, and (while respecting equity) targeting high‐quality differentiated, comprehensive prevention and treatment interventions to specific localities; and (d) capacitating communities to work across all levels of the health response, enabling them to utilize and respond to evidence and achieve impact .…”

mentioning

confidence: 99%

Getting local: focusing on communities to achieve greater impact in the next phase of the HIV response

2019

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Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission

Cited by 250 publications

References 159 publications

90‐90‐90 by 2020? Estimation and projection of the adult HIV epidemic and ART programme in Zimbabwe – 2017 to 2020

90‐90‐90 by 2020? Estimation and projection of the adult HIV epidemic and ART programme in Zimbabwe – 2017 to 2020

Patient–provider perspectives on self‐management support and patient empowerment in chronic care: A mixed‐methods study in a rural sub‐Saharan setting

Getting local: focusing on communities to achieve greater impact in the next phase of the HIV response

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