How can we get close to zero? The potential contribution of biomedical prevention and the investment framework towards an effective response to HIV.
BACKGROUND
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. However, it also estimated a leveling in the number of new infections at about 1 million annually after 2015.


METHODS
We 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.


RESULTS
Immediate 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.


CONCLUSIONS
In 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.
Futures Institute, Glastonbury, Connecticut, United States of America.
John
J
Stover
Imperial College London, London, United Kingdom.
Timothy B
TB
Hallett
China Centers for Disease Control, Beijing, China.
Zunyou
Z
Wu
AIDS Vaccine Advocacy AVAC, New York, New York, United States of America.
Mitchell
M
Warren
Futures Institute, Glastonbury, Connecticut, United States of America.
Chaitra
C
Gopalappa
Futures Institute, Glastonbury, Connecticut, United States of America.
Carel
C
Pretorius
United Nations Joint Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
Peter D
PD
Ghys
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
Julio
J
Montaner
World Health Organization (WHO), Beijing, China.
Bernhard
B
Schwartländer
D020811:Biomedical Technology / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006295:Health Resources; D006801:Humans; D007449:Investments / Q000191:economics; D008962:Models, Theoretical; D009026:Mortality; D011788:Quality of Life; D012959:Socioeconomic Factors