Achieving UNAIDS 90-90-90: More haste less speed?

UNAIDS (2014) has set targets for HIV management that seem ambitious, if not unrealistically so  (UNAIDS: 90-90-90): 90% of those living with HIV to know their status; 90% of known HIV+ individuals to undergo ART initiation; 90% of ART+ initiated to achieve viral suppression. A one-year-in report from a large cluster-randomized study of home-based testing […]

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HPTN 071 attempts universal home-based HIV testing in sub-Saharan Africa: scaling the mountainous challenge of UNAIDS 90-90-90 target

Estimates of 96% for the preventative efficacy of ART against HIV transmission, reported in 2011 by Myron & Cohen (M&C), appeared at last to place long-term containment of the epidemic in our hands.  In the wake of this, UNAIDS: 90-90-90 proposed ambitious targets: 90% of those living with HIV to know their status; 90% of […]

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The PrEP ‘care continuum/cascade’: how would it look?

We take for granted the value of the care continuum (or ‘cascade’), now increasingly seen as the key measure of health system response to HIV (Cassell (STIs editorial)).   The application of this model to HIV has provided a benchmark for evaluation in contexts as diverse as Moscow (Wirtz & Beyrer (STIs)), South Africa (Schwartz & […]

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A case for immediate ART initiation in all HIV diagnosed, regardless of CD4+ count?

The year 2013 saw the WHO recommended threshold for treatment of HIV+ patients with ART rise from a count of 350 CD4+ per mm3 to one of 500 CD4+ per mm3.. The threshold had been fixed as early as three years before (2010) at 350 CD4+ per mm3 (WHO ART recommendations). These recommendations have doubtless […]

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Retention in care rather than diagnosis may prove the ultimate challenge for US HIV response

The real challenge which the US HIV/AIDS epidemic poses for the US public health services is not simply to achieve higher levels of diagnosis – but, far more than that, to improve linkage to, and retention in, care.  This claim is hardly controversial. But it is thrown into stark relief in a recent study by […]

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