How can we get close to zero? The potential contribution of biomedical prevention and the investment framework towards an effective response to HIV.

John Stover,Julio Montaner,Carel Pretorius,Bernhard Schwartländer,Mitchell Warren,Zunyou Wu,Peter D Ghys,Timothy B Hallett,Chaitra Gopalappa,Julian W Tang

doi:10.1371/journal.pone.0111956

Abstract

BackgroundIn 2011 an Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services resulting in a reduction of new HIV infections by more than half. However, it also estimated a leveling in the number of new infections at about 1 million annually after 2015.MethodsWe modeled how the response to AIDS can be further expanded by scaling up antiretroviral treatment (ART) within the framework provided by the 2013 WHO treatment guidelines. We further explored the potential contributions of new prevention technologies: ‘Test and Treat’, pre-exposure prophylaxis and an HIV vaccine.FindingsImmediate aggressive scale up of existing approaches including the 2013 WHO guidelines could reduce new infections by 80%. A ‘Test and Treat’ approach could further reduce new infections. This could be further enhanced by a future highly effective pre-exposure prophylaxis and an HIV vaccine, so that a combination of all four approaches could reduce new infections to as low as 80,000 per year by 2050 and annual AIDS deaths to 260,000.InterpretationIn a set of ambitious scenarios, we find that immediate implementation of the 2013 WHO antiretroviral therapy guidelines could reduce new HIV infections by 80%. Further reductions may be achieved by moving to a ‘Test and Treat’ approach, and eventually by adding a highly effective pre-exposure prophylaxis and an HIV vaccine, if they become available.

Highlights

In 2011 a new Investment Framework for HIV/AIDS was proposed to guide efforts in the coming years towards the rational use of resources to confront the AIDS epidemic [1]
Similar to the work undertaken for the 2011 Investment Framework, we used the Goals model [11], part of the Spectrum software package, to model the potential impact of different interventions in 24 countries accounting for 85% of new infections in low- and middle-income countries as classified by the World Bank in 2012 (Table 1)
An expansion of prevention and treatment programs to achieve the targets of the original Investment Framework could reduce the annual number of new infections in low- and middle-income countries by 77% by 2050 compared to 2011, but about 750,000 people would still be newly infected each year (Figure 2)

Summary

Introduction

In 2011 a new Investment Framework for HIV/AIDS was proposed to guide efforts in the coming years towards the rational use of resources to confront the AIDS epidemic [1]. In 2011 an Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services resulting in a reduction of new HIV infections by more than half. It estimated a leveling in the number of new infections at about 1 million annually after 2015

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Conclusion