Achieving the 90-90-90 target news

ART has averted over 850,000 HIV-related opportunistic infections in low and middle income countries

Rollout of antiretroviral therapy (ART) in low and middle income countries has averted over 850,000 cases of HIV-related opportunistic infections at a saving of at least $47 million per year, according to a systematic review and meta-analysis published in Clinical Infectious Diseases. Incidence of opportunistic infections (OIs) declined by between 57-91% in the first year after starting ART, with the greatest reductions in cases of oral thrush, toxoplasmosis and PCP pneumonia.

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Expanding treatment and PrEP could prevent 185,000 new HIV infections, US CDC says

Increasing diagnosis, care and treatment of people living with HIV could lead to a large decrease in HIV incidence, preventing some 168,000 new infections by the year 2020, according to a new US Centers for Disease Control and Prevention (CDC) analysis presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston. The impact of pre-exposure prophylaxis (PrEP) would be comparatively modest, but its importance would be greater if more people with HIV are not on treatment with undetectable viral load.

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Rate of entry into HIV care improved by personalised counselling

Entry into HIV care can be increased by around 40% if people receive a point-of-care CD4 test and counselling sessions to overcome personal barriers to seeking HIV care, a large randomised study in South Africa has shown. However, the study also found that only half of the people who received the most effective linkage intervention and who were in need of immediate treatment made it onto treatment within six months of their HIV diagnosis, highlighting the need for further improvements in linkage to HIV care.

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Studies probe retention in HIV care for women who start antiretroviral treatment during pregnancy

Engaging lay counsellors to provide a combination package of evidence-based interventions in Nyanza, Kenya and addressing partner disclosure, as well as pre-treatment education about the benefits of antiretroviral therapy (ART) for maternal and child health in Malawi’s Option B+ programme, improved retention in care and reduced loss to follow-up of mothers with HIV and their infants, studies presented at CROI 2016 show.

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Option B+ has enabled Malawi to make significant progress towards 90-90-90

In four years, Malawi’s treatment cascade for pregnant women has been transformed so that the proportion of women with HIV who are diagnosed has gone from 49 to 80%, and the proportion who are virally suppressed has jumped from 2 to 48%, CROI 2016 heard.

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Large-scale household TB screening shows feasibility in PopART trial

Offering TB screening as part of a home-based HIV testing intervention has the potential to identify numerous TB cases that would otherwise have gone undiagnosed, a report from a large community-based study in Zambia shows. The findings, from the PopART study, were reported by Comfort Phiri of Zambart at CROI 2016.

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Removing clinic barriers to rapid initiation of ART in Uganda enables 70% to start on the same day

Making point-of-care CD4 count diagnostics available, revising adherence counselling requirements and giving extra training to healthcare workers can almost quadruple the number of patients who begin antiretroviral therapy on the day that they are eligible, Gideon Amanyire of Makerere University told CROI 2016. The package of health system reforms was provided to a typical, ‘real world’ group of clinics and was embedded in everyday practice, suggesting that the same intervention could have a similar impact elsewhere.

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PopART trial shows feasibility of reaching 90-90-90 targets for testing and treatment coverage in Zambia and South Africa

Early findings from the PopART study of the impact of a test-and-treat strategy on antiretroviral treatment coverage and HIV incidence show that after one round of household-based testing, linkage to care and offer of immediate antiretroviral treatment, 90% of adults knew their HIV status and 71% of adults diagnosed with HIV were on treatment.

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Botswana close to reaching the 90-90-90 testing and treatment targets

Botswana is already close to reaching the 90-90-90 target for testing, treatment and viral suppression, and is ahead of the United States and most European countries in its efforts to improve treatment coverage, Tendani Gaolathe of the Botswana-Harvard AIDS Institute Partnership reported at CROI 2016.

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Option B+ cuts mother-to-child HIV transmission dramatically in Malawi

Among women on antiretroviral therapy (ART) prior to pregnancy, early mother-to-child transmission in Malawi’s Option B+ programme compares favourably to transmission rates observed in developed countries, Sundeep Gupta told participants at CROI 2016.

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Starting HIV treatment at first clinic visit improves outcomes in African study

A programme to accelerate the process of HIV diagnosis, preparation and starting antiretroviral therapy (ART) in South Africa led to a higher proportion of people initiating treatment and better health outcomes, according to results from the RapIT trial presented at CROI 2016.

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During pregnancy, offering HIV testing at home doubles the proportion of male partners who test

A programme of home visits, partner education and HIV testing for couples in Kenya was able to double the proportion of men who tested during their partner’s pregnancy, Carey Farquhar of the University of Washington told CROI 2016. Partners became aware of each other’s HIV status without this being linked to an increase in intimate partner violence.

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Progress towards 90-90-90: news highlights from other sources

South Africa rolls out ‘test and treat’ to sex workers

from Health-e

South Africa has become one of the world’s first countries to begin rolling out PrEP (pre-exposure prophylaxis) as well as ‘test and treat’ to sex workers as it launches Africa’s first plan to prevent and treat HIV among sex workers.

UNAIDS calls for 20 billion condoms by 2020

from UNAIDS

UNAIDS is calling for increased investments by donors and governments for the promotion and distribution of male and female condoms in order to ensure everyone has access to condoms to protect themselves and their partners from HIV, STIs and unintended pregnancies.

Woman’s Condom achieves WHO/UNFPA prequalification

from PATH

The Woman’s Condom, a new female condom designed to be easy to use and more acceptable to women and their partners, has been prequalified by the World Health Organization (WHO)/United Nations Population Fund (UNFPA). The approval marks a critical step forward in expanding options for female-initiated dual protection from pregnancy and sexually transmitted infections (STIs), including HIV.

The case for a harm reduction decade

from Harm Reduction International

HIV-related deaths and new HIV infections among people who inject drugs could be almost entirely eliminated by 2030 with just a tiny shift in global drug control spending. This is one finding of our report The Case for a Harm Reduction Decade.

Malawi tests first unmanned aerial vehicle flights for HIV early infant diagnosis

from UNICEF

The Government of Malawi and UNICEF have started testing the use of Unmanned Aerial Vehicles (UAVs or drones) to explore cost-effective ways of reducing waiting times for HIV testing of infants. The test, which is using simulated samples, will have the potential to cut waiting times dramatically, and if successful, will be integrated into the health system alongside others mechanisms such as road transport and SMS. 

Report shows that transgender people are left behind in the fight against HIV 

from Global Fund Observer

Transgender people are the most affected by HIV but remain largely excluded from policy, programme, and funding decisions at national, regional, and global levels, according to a report released in February. Out of more than 130 CCMs, only 17 have transgender representatives.

News from aidsmap

Combination inhibitor BMS-986197 demonstrates good activity against HIV in early study

A long-acting bio-engineered molecule with a triple mechanism of action demonstrated potent antiviral activity and worked against HIV that developed resistance to any one of the three mechanisms in a laboratory study, and lowered viral load in humanised mice, according to research presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2016) last month in Boston.

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Starting HIV therapy associated with improvements in liver function, especially when viral load is suppressed

Starting antiretroviral therapy is associated with improvements in liver function in HIV-positive men with and without viral hepatitis co-infection, investigators from the United States report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

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High sexually transmitted infection rates among men on PrEP supports more frequent monitoring

Participants taking tenofovir/emtricitabine (Truvada) for pre-exposure prophylaxis (PrEP) continued to have high rates of sexually transmitted infections (STIs) in two US PrEP demonstration projects, according to a pair of reports at CROI 2016. Semi-annual STI testing missed many cases, leading researchers to suggest that gay men on PrEP could benefit from screening every three months.

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HIV-related factors increase risk of stroke

HIV-related risk factors seem to increase the risk of stroke – the sudden death of brain cells due to a rupture or obstruction of blood vessels in the brain – according to ongoing research in a growing number of large epidemiological cohort studies. Recent data from five of these were presented during the first-ever poster discussion session on stroke at CROI 2016.

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Sofosbuvir/velpatasvir for hepatitis C can be administered with most antiretrovirals

Sofosbuvir/velpatasvir, a forthcoming combination that effectively treats all hepatitis C virus (HCV) genotypes, can be safely used with most boosted antiretrovirals for people with HIV and HCV co-infection, according to a study presented at CROI 2016.

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Transgender people are at high risk for HIV, but too little is known about prevention and treatment for this population

Transgender women have among the highest rates of HIV infection but little is known about HIV prevalence among trans men, Tonia Poteat of Johns Hopkins Bloomberg School of Public Health said in a plenary lecture on transgender health and HIV at CROI 2016 – the first ever on this population at CROI. A growing number of studies and prevention and treatment programmes are addressing transgender populations, but more research is needed.

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Rapid rise in PrEP awareness in US gay men, but only 5% have used PrEP

Large internet surveys of American gay men show that the proportion who have heard of pre-exposure prophylaxis (PrEP) jumped from 45% in 2012 to 68% in 2015, with around half of men willing to consider using PrEP – but that actual usage is far lower and remains concentrated in a few key urban areas where public health authorities have facilitated its uptake.

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Indiana HIV epidemic among people who inject drugs is controlled, but ongoing vigilance is needed

Extensive epidemiological investigation followed by prevention and treatment interventions have largely succeeded in controlling an outbreak of HIV and hepatitis C virus (HCV) infection in rural Indiana, USA, linked to injection of prescription opioids, but new cases continue to appear and many other communities may be at risk for similar outbreaks, according to presentations at CROI 2016.

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Ravidasvir plus sofosbuvir demonstrates high cure rate for people with hepatitis C genotype 4

Sofosbuvir plus the investigational HCV NS5A inhibitor ravidasvir, with or without ribavirin, cured 95 to 100% of people with hepatitis C virus (HCV) genotype 4, the most common type in Egypt, according to findings from the Pyramid 1 study presented at CROI 2016.

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Editors' picks from other sources

Where is PrEP? Write to the CEO of NHS England about it

from NAT

NHS England are considering whether and how to make PrEP available. A final decision was due this June but for that to happen, the NHS must first open a public consultation for a minimum of 30 days. The latest deadline for opening the consultation is fast approaching and it has not been released. There is urgent concern about how this might impact on whether PrEP is made available in England. Email Simon Stevens, Chief Executive of NHS England using this form, to ask him to make the consultation available immediately.

AIDS advocates from across the US call upon presidential candidates to make ending the epidemic a priority

from TAG

Secretary Clinton's mischaracterisation of the Reagan Administration on Friday March 11, sparked nationwide upset from HIV/AIDS advocates, service providers, people living with HIV, and loved ones of those lost to the epidemic. But it also has created an opportunity to bring HIV/AIDS to the forefront of the conversation during this campaign season.

Free ARVs are not enough: the hidden costs of treating HIV in Nigeria

from The Conversation

The Nigerian government’s decision to provide antiretrovirals freely as part of HIV programmes at the country’s health facilities has dramatically improved the uptake of treatment. But it has not been enough to eliminate the high and sometimes inequitable economic burden of HIV/AIDS on households. Exorbitant food and transport costs, as well as the costs of illnesses linked to HIV, hinder full access to treatment services. Households end up having to fork out money they don’t necessarily have.

The man who was wrongly labelled as HIV's 'Patient Zero'

from New York Magazine

Flight attendant Gaetan Dugas couldn’t have started the epidemic in the 1980s, because the virus had already been around in the US since the early 1970s, beginning in New York City in 1970 – likely coming from someone who had caught the virus in Haiti or a nearby country – and then spreading to San Francisco by 1975.