Modelling the scale-down of HIV services in sub-Saharan Africa

Search BMJ STI archive, and you will find frequent references to ‘scaling up’, and few – if any – to ‘scaling back’ or ‘scaling down’ (other than Parker/STI).  Who knows if all this may not be about to change, if the US government goes ahead with threats to cut current foreign aid budget ear-marked for […]

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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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Health vulnerability of peri-natally HIV-infected youth: a growing problem throughout the world

Mother-to-child, or ‘vertical’, transmission of HIV is not just a problem for developing countries; even in countries like the US and the UK, peri-natal transmission has probably not been eliminated.  But, with routine ‘opt-out’ ante-natal testing (BHIVA guidelines on HIV testing), cases are increasingly likely to involve births that have taken place overseas or before […]

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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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UNAIDS 2016 Report: How a ‘life-cycle’ approach can help the world ‘get on the fast track’ to HIV prevention

‘Get on the Fast Track: a Life-cycle Approach to HIV’ is the latest UNAIDS report, following on from the UN Assembly’s 2016 declaration of commitment to ‘Fast Track’ goals for ending the HIV/AIDS epidemic. The major theme of the ‘life-cycle’ appears to owe much to the findings of the South African CAPRISA study – above […]

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Inadequacy of ‘treatment as prevention’ strategy for combating HIV in young US MSM

The secret of containing the HIV epidemic is the successful engagement of key populations, we are told. In the case of the US that evidently includes young MSM (YMSM), amongst others.  The scale of the task that confronts public health interventions aimed at prevention in this group is brought out in a recent study by Wilson & Hightow-Weidmann  […]

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Can financial incentives help address the problem of HIV lost-to-follow-up in the US?

An article by Skarbinski & Mermin, discussed in my recent blog, Skarbinski & Mermin (STI/blogs), throws into sharp light the problem of the 45.2% of the HIV/AIDS infected population who are diagnosed but lost to follow-up.  According to their estimate this group are responsible for 61.3% of transmissions.  Various local attempts have been made to […]

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