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Gupta S.,International Association of Providers of AIDS Care | Granich R.,International Association of Providers of AIDS Care
Journal of the International Association of Providers of AIDS Care | Year: 2017

We reviewed published national HIV care continua for men who have sex with men (MSM), people who inject drugs (PWID), and female sex workers (FSWs) to track progress toward the 90-90-90 target. We searched the Internet, PubMed, surveillance reports, United Nations Programme on HIV/AIDS country reports, US President's Emergency Plan for AIDS Relief country/regional operational plans, and conference abstracts for the continua and graded them on quality. We found 12 continua for MSM, 7 for PWID, and 5 for FSW from 12 countries. HIV diagnosis, antiretroviral therapy coverage, and viral suppression varied between (1) 5% and 85%, 2% and 73%, and 1% and 72%, respectively for MSM; (2) 54% and 96%, 14% and 80%, and 8% and 68%, respectively for PWID; and (3) 27% and 63%, 8% and 16%, and 2% and 14%, respectively for FSW. Two countries, using data from national cohorts, were high quality. There are limited key population continua in the public domain. Of the few available, none have achieved 90-90-90. Improved monitoring and evaluation of key population continua is necessary to achieve the 90-90-90 target. © SAGE Publications.


Suthar A.B.,Stellenbosch University | Granich R.M.,International Association of Providers of AIDS Care | Kato M.,World Health Organization | Nsanzimana S.,Rwanda Biomedical Center | And 2 more authors.
Journal of Infectious Diseases | Year: 2015

Human immunodeficiency virus (HIV) infection includes acute, early, chronic, and late stages. Acute HIV infection lasts approximately 3 weeks and early HIV infection, which includes acute HIV infection, lasts approximately 7 weeks. Many testing and blood screening algorithms detect HIV antibodies about 3 weeks after HIV infection. Incidence estimates are based on results of modeling, cohort studies, surveillance, and/or assays. Viral load is the key modifiable risk factor for HIV transmission and peaks during acute and early HIV infection. Empirical evidence characterizing the impact of acute and early HIV infection on the spread of the HIV epidemic are limited. Time trends of HIV prevalence collected from concentrated and generalized epidemics suggest that acute and early HIV infection may have a limited role in population HIV transmission. Collectively, these data suggest that acute and early HIV infection is relatively short and does not currently require fundamentally different programmatic approaches to manage the HIV/AIDS epidemic in most settings. Research and surveillance will inform which epidemic contexts and phases may require tailored strategies for these stages of HIV infection. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.


Sidibe M.,Joint United Nations Programme on HIV AIDS | Zuniga J.M.,International Association of Providers of AIDS Care
Clinical Infectious Diseases | Year: 2014

We have the tools at our disposal to significantly bend AIDS-related morbidity and mortality curves and reduce human immunodeficiency virus (HIV) incidence. It is thus essential to redouble our efforts to reach the goal of placing 15 million people on life-saving and-enhancing antiretroviral therapy (ART) by 2015. In reaching this milestone, we can write a new chapter in the history of global health, demonstrating that a robust, multidimensional response can succeed against a complex pandemic that presents as many social and political challenges as it does medical ones. This milestone is also critical to advance our ultimate goal of ending AIDS by maximizing the therapeutic and preventive effects of ART, which translates into a world in which AIDS-related deaths and new HIV infections are exceedingly rare. © 2014 The Author . Published by Oxford University Press on behalf of the Infectious Diseases Society of America.


PubMed | Cornell University, Stellenbosch University and International Association of Providers of AIDS Care
Type: Journal Article | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2016

Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcomes such as disease progression, mortality, and HIV transmission in people living with HIV. CD4 counts also vary widely within individuals and among populations, leading to imprecise measurements and arbitrary ART initiation. To capture the clinical and preventive benefits of treatment, the global HIV response now focuses on increasing HIV diagnosis and ART coverage. CD4 counts for ART initiation were necessary when medications were expensive and had severe side effects, and when the impact of early ART initiation was unclear. However, current evidence suggests that although CD4 counts may still play a role in guiding clinical care to start prophylaxis for opportunistic infections, CD4 counts should cease to be required for ART initiation.


Hoy J.,Monash University | Young B.,International Association of Providers of AIDS Care
Current Opinion in HIV and AIDS | Year: 2016

Purpose of review This review details recent findings that inform the prevalence and incidence of fractures in people living with HIV (PLWH) and examines the effects of HIV infection and antiretroviral therapy (ART), as well as demographics and traditional risk factors on fractures. As antiretroviral guidelines have recently changed to recommend the introduction of ART at diagnosis of HIV infection, the long-term effects of ART on bone health and fracture risk need to be better understood. Recent findings It is apparent that both the effects of HIV infection alone and initiation of ART are associated with significant bone loss in individuals with HIV infection, resulting in osteopenia and osteoporosis. The clinical consequence of low bone mineral density is a greater risk of fragility fractures that are more common in older HIV patients, and those on ART. Frailty occurs at a prevalence of about 10% (about twice that of the general population), and the increased propensity of falls results in greater fracture prevalence, morbidity and mortality. Summary This review examines data from recent cohort studies and clinical trials to inform a better understanding of the complex relationship between the effects of HIV infection, ART and demographics on fractures in PLWH. © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Pineirua A.,Emory University | Pineirua A.,Instituto Nacional Of Ciencias Medicas Y Nutricion Salvador Zubiran | Sierra-Madero J.,Instituto Nacional Of Ciencias Medicas Y Nutricion Salvador Zubiran | Cahn P.,Juan A Fernandez Hospital | And 5 more authors.
The Lancet Infectious Diseases | Year: 2015

Combination antiretroviral therapy (ART), also known as highly active antiretroviral therapy, provides clinical and immunological benefits for people living with HIV and is an effective strategy to prevent HIV transmission at the individual level. Early initiation of ART as part of a test and treat approach might decrease HIV transmission at the population level, but to do so the HIV continuum of care, from diagnosis to viral suppression, should be optimised. Access to ART has improved greatly in Latin America, and about 600 000 people are on treatment. However, health-care systems are deficient in different stages of the HIV continuum of care, and in some cases only a small proportion of individuals achieve the desired outcome of virological suppression. At present, data for most Latin American countries are not sufficient to build reliable metrics. Available data and estimates show that many people living with HIV in Latin America are unaware of their status, are diagnosed late, and enter into care late. Stigma, administrative barriers, and economic limitations seem to be important determinants of late diagnosis and failure to be linked to and retained in care. Policy makers need reliable data to optimise the HIV care continuum and improve individual-based and population-based outcomes of ART in Latin America. © 2015 Elsevier Ltd.


Young B.,International Association of Providers of AIDS Care | Zuniga J.M.,International Association of Providers of AIDS Care | Montaner J.,University of British Columbia | Mayer K.H.,Beth Israel Deaconess Medical Center
Clinical Infectious Diseases | Year: 2014

The second Controlling the HIV With Antiretrovirals evidence summit was held 22-24 September 2013, in London, England. This preface summarizes the summit's background and key themes, and is an introduction to a series of articles written by select summit faculty and featured in this supplement. In many respects, the supplement can serve as a roadmap for how to move from general consensus around to wider scale implementation of a comprehensive menu of interventions to control the HIV epidemic. © 2014 The Author .


Zuniga J.M.,International Association of Providers of AIDS Care | Young B.,International Association of Providers of AIDS Care
Journal of the International Association of Providers of AIDS Care | Year: 2013

Engagement in care is directly linked to achieving HIV viral suppression, yet over the past 2 years analyses of data related to the US HIV epidemic have revealed that many people living with HIV/AIDS are failing to successfully navigate the HIV treatment cascade, with only between an estimated 19% and 28% achieving the ultimate goal of antiretroviral therapy (ART): viral suppression. We propose a clinical management algorithm that captures key operational interventions recommended in recently published guidelines on entry into and retention in care and ART adherence. © The Author(s) 2012.


Zuniga J.M.,International Association of Providers of AIDS Care
Journal of the International Association of Providers of AIDS Care | Year: 2015

Background: An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART. Methods: A systematic literature search was conducted, and 6132 articles, including randomized controlled trials, observational studies with or without comparators, cross-sectional studies, and descriptive documents, met the inclusion criteria. Of these, 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents. Recommendations: Recommendations are provided for interventions to optimize the HIV care environment; increase HIV testing and linkage to care, treatment coverage, retention in care, and viral suppression; and monitor the HIV care continuum. © The Author(s) 2015.


PubMed | South African Center for Epidemiological Modelling and Analysis, International Association of Providers of AIDS Care and British Columbia Center for Excellence
Type: Journal Article | Journal: Journal of the International Association of Providers of AIDS Care | Year: 2016

: Achieving the 90-90-90 targets by 2020 requires increased focus, resources, and efficiency to provide earlier access to antiretroviral therapy (ART).We used 2009 to 2013 National AIDS Spending Assessment data to assess HIV care and treatment spending in 38 high-burden, low- and middle-income countries (LMICs).In 2013, 23 of the 38 high-burden countries spent less than 50% of total HIV spending on care and treatment. HIV spending on ART per people living with HIV (PLHIV; adjusted) averaged US$299 (US$32-US$2463). During 2009 to 2013, a 10% increase in average spending on care and treatment per PLHIV was associated with an increase in ART coverage of 2.4% and a decrease in estimated AIDS-related death rate of 2.4 per 1000 PLHIV.HIV spending in high-burden LMICs does not consistently reflect the new science around the preventative and clinical benefits of earlier HIV diagnosis and ART initiation.

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