New HIV data from sub-Saharan Africa highlight challenges and reasons for hope

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Researchers and public health experts presented promising new data on the HIV epidemic and response in sub-Saharan Africa at the 22nd International AIDS Conference (AIDS 2018) today.

While a UNICEF study highlighted the ongoing toll of HIV among young people in the region, data from several African countries demonstrated how enhanced HIV prevention and treatment programmes can dramatically reduce the impact of the epidemic.

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“Despite extraordinary progress, HIV remains a serious threat to the lives of millions of people in sub-Saharan Africa,” Linda-Gail Bekker, President of the International AIDS Society and International Chair of AIDS 2018, said. “The data presented today underscore both the urgent need and the opportunity to invest in expanded HIV prevention and treatment programmes that can turn back the epidemic in Africa.”

Today’s press conference highlighted five abstracts being presented at AIDS 2018.

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Note: Press summaries are based on abstracts; final data presented at the conference may change

Study projects heavy toll of HIV on young people in sub-Saharan Africa

An analysis conducted by UNICEF estimated that 9.6 million young people aged 15-24 years will be newly infected with HIV in sub-Saharan Africa between 2017 and 2050. About two-thirds of those will be girls or young women, according to the study. The continued toll of HIV among young people reflects the rapidly growing youth population in the region, which is expected to increase by 85% by 2050, as well as the slow decline in HIV incidence in this group, which has fallen by some 3% per year since 2010.

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Presenting the data, Aleya Khalifa of UNICEF noted that reducing the HIV burden among young people in sub-Saharan Africa will require better access to HIV prevention, sexual and reproductive health, and targeted testing services. [Summary based on submitted abstract; updated data may be presented on site.]

Abstract: Demographic transitions and the future of the HIV epidemic for children and adolescents

Session: New tools, old tricks: Innovative methods for understanding the epidemic (Hall 11B, Thursday, 26 July, 11:00-12:30)

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Namibia surpasses target for viral suppression

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A population-level study in Namibia (NAMPHIA) found that 77% of people living with HIV in the country are virally suppressed; that is, the HIV level in their blood has fallen to low levels. Viral suppression indicates that people living with HIV are on successful treatment, which not only improves their health, but also prevents transmission to others.

Presenter Bernard Haufiku, Namibian Minister of Health and Social Services, noted that Namibia surpassed the UNAIDS goal of achieving 73% viral suppression by 2020. Its success reflects a high-level commitment to HIV treatment: in 2015, Namibia implemented an Acceleration Plan that rapidly scaled up HIV testing and treatment services. [Summary based on submitted abstract; updated data may be presented on site.]

Abstract: Progress toward HIV epidemic control: Results from the Namibia Population-Based HIV Impact Assessment (PHIA)

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Session: Pedal to the Metal: Accelerating the Cascade (Forum, Thursday, 26 July, 16:30-18:00)

Randomized trial demonstrates impact of HIV “test-and-treat” strategy

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Data from SEARCH, a community-cluster randomized study in Uganda and Kenya, showed that enhanced testing and care initiatives for HIV and other diseases can result in significantly higher viral suppression and lower HIV mortality.

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Communities in the study control group received testing and care for HIV-related hypertension and diabetes based on national guidelines. Communities in the intervention group received enhanced testing and care for the three diseases, including rapid-start treatment for all people living with HIV. After three years, communities receiving enhanced testing and care experienced higher viral suppression and lower HIV mortality, TB incidence and uncontrolled hypertension.

Presenting the data, Diane Havlir of the University of California San Francisco concluded that a multi-disease approach using streamlined care can rapidly achieve UNAIDS targets for HIV treatment and improve community health. [Summary based on submitted abstract; updated data may be presented on site.]

Abstract: SEARCH community cluster randomized study of HIV “test and treat” using multi- disease approach and streamlined care in rural Uganda and Kenya

Session: AIDS 2018 Co-chairs’ Choice (Hall 12, Wednesday, 25 July, 11:00-12:30)

Botswana study shows effectiveness of combination HIV prevention approach

The Ya Tsie Botswana Prevention Project, a randomized study in rural and semi-urban communities, found that a package of interventions, including expanded HIV testing, linkage to care, earlier treatment and voluntary male circumcision, led to 30% reduction in HIV incidence. The study compared outcomes over 30 months from 15 communities receiving the interventions and 15 communities receiving the standard of care.

Moeketsi Joseph Makhema of the Botswana Harvard AIDS Institute Partnership presented the findings, noting that they provided strong real-world evidence for the efficacy of this approach in settings with high HIV prevalence and relatively high HIV treatment coverage, such as Botswana. [Summary based on submitted abstract; updated data may be presented on site.]

Abstract: Impact of prevention and treatment interventions on population HIV incidence: Primary
results of the community-randomized Ya Tsie Botswana prevention project

Session: AIDS 2018 Co-chairs’ Choice (Hall 12, Wednesday 25 July, 11:00-12:30)

First trial of “universal test and treat” in a government health system shows benefits

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The MaxART study in eSwatini (previously known as Swaziland) provided the world’s first data on the impact of “universal test and treat” (UTT) in a government-run national health system; UTT entails offering antiretroviral treatment to all HIV-positive individuals, regardless of CD4 count. The study evaluated data from 14 health facilities as they transitioned from the current standard of care to UTT.

Velephi Okello of the eSwatini Ministry of Health reported that adopting UTT led to improved health system performance. The likelihood of achieving viral suppression improved dramatically, with 79% of patients achieving viral suppression under UTT compared with just 4% under the current standard of care. Patients under UTT were also 60% more likely to be retained in care.

Abstract: Universal test and treat (UTT) versus standard of care for access to antiretroviral therapy in HIV clients: The MaxART stepped-wedge randomized controlled health systems trial in Swaziland

Session: AIDS 2018 Co-chairs’ Choice (Hall 12, Wednesday, 25 July, 11:00-12:30)

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