title: The Art of HIV Elimination: Past and Present Science.
abstract: BACKGROUND
  Remarkable strides have been made in controlling the HIV epidemic, although not enough to achieve epidemic control. More recently, interest in biomedical HIV control approaches has increased, but substantial challenges with the HIV cascade of care hinder successful implementation. We summarise all available HIV prevention methods and make recommendations on how to address current challenges.
  
  
  CONCLUSIONS
  In the early days of the epidemic, behavioural approaches to control the HIV dominated, and the few available evidence-based interventions demonstrated to reduce HIV transmission were applied independently from one another. More recently, it has become clear that combination prevention strategies targeted to high transmission geographies and people at most risk of infections are required to achieve epidemic control. Biomedical strategies such as male medical circumcision and antiretroviral therapy for treatment in HIV-positive individuals and as pre-exposure prophylaxis in HIV-negative individuals provide immense promise for the future of HIV control. In resource-rich settings, the threat of HIV treatment optimism resulting in increased sexual risk taking has been observed and there are concerns that as ART roll-out matures in resource-poor settings and the benefits of ART become clearly visible, behavioural disinhibition may also become a challenge in those settings. Unfortunately, an efficacious vaccine, a strategy which could potentially halt the HIV epidemic, remains elusive.
  
  
  CONCLUSIONS
  Combination HIV prevention offers a logical approach to HIV control, although what and how the available options should be combined is contextual. Therefore, knowledge of the local or national drivers of HIV infection is paramount. Problems with the HIV care continuum remain of concern, hindering progress towards the UNAIDS target of 90-90-90 by 2020. Research is needed on combination interventions that address all the steps of the cascade as the steps are not independent of each other. Until these issues are addressed, HIV elimination may remain an unattainable goal.
authors: Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa; Research Department of Infection and Population Health, University College London, UK.
authors: Collins C
authors: CC
authors: Iwuji
authors: Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa; Academic Unit of Primary Care and Population Sciences, and Department of Social statistics and Demography, University of Southampton, UK.
authors: Nuala
authors: N
authors: McGrath
authors: Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa.
authors: Tulio
authors: T
authors: de Oliveira
authors: MRC Clinical Trials Unit at UCL, London, UK.
authors: Kholoud
authors: K
authors: Porter
authors: Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa; Research Department of Infection and Immunity, University College London, UK.
authors: Deenan
authors: D
authors: Pillay
authors: Division of Medicine, Brighton and Sussex Medical School, UK.
authors: Martin
authors: M
authors: Fisher
authors: Department of Infectious Diseases and Global Health, Brighton and Sussex Medical School, UK.
authors: Melanie
authors: M
authors: Newport
authors: Faculty of Medicine and Faculty of Social and Human Sciences, University of Southampton, UK.
authors: Marie-Louise
authors: ML
authors: Newell
keywords: Antiretroviral therapy; Combination HIV prevention; HIV; HIV cascade; HIV vaccines; Post-exposure prophylaxis; Pre-exposure prophylaxis