By Center for Dissemination & Implementation • December 7, 2023
In an article published in The Lancet on World AIDS Day, Dec. 1, researchers Aaloke Mody, MD and Elvin Geng, MD, WashU physicians in infectious disease, provide insights into the evolving landscape of the global HIV response, offering updates on the current state of HIV epidemiology, treatment, and prevention. Their comprehensive review emphasizes the significant progress achieved, with new infections and deaths decreasing by 53% and 68%, respectively, since their peaks roughly two decades ago. As of 2021, 85% of all people living with HIV (PLWH) were aware of their HIV status, 75% were receiving life-saving antiretroviral therapy, and 68% had achieved viral suppression—the key indicator of successful treatment. The available options for treatment and prevention are now multiple, safe, effective, and durable, with newer injectable choices enabling simplified and more convenient dosing schedules (e.g., doses needed only every two- or six-months). Additionally, it is abundantly clear that successful treatment, equated with viral suppression, entirely prevents onward transmission, encapsulated in the maxim “undetectable=untransmittable” (U=U).
However, Mody, Geng, and colleagues highlight that this progress is ushering the HIV epidemic into a new phase, accompanied by new and emerging challenges. Despite the availability of remarkable innovations in both treatment and prevention, they often fail to reach large segments of the global population, particularly those who have historically been more vulnerable and marginalized. Disparities in access and uptake persist among racial minorities, young women, those living in poverty, people engaged in sex work, people who inject drugs, and sexual minority men, undermining progress and preventing the realization of the full potential of public health impact. The authors advocate that the most substantial challenges in combating HIV today do not stem from the absence of effective tools but from the need for equitable, accessible and high-quality implementation of HIV testing, prevention and treatment services.
The researchers point to the potential of implementation science as a means to develop innovations in the delivery of HIV services and bridge the gap between groundbreaking scientific advances and real-world application. They highlight examples of innovative care delivery strategies that extend HIV testing, treatment or prevention options beyond traditional health system venues, and integrate a broader spectrum of health services to better align with client needs and preferences. Their work serves as both a beacon of hope and a clarion call for action, reminding us that while we may have the tools to end the HIV epidemic, our success will ultimately be measured by our ability to implement these tools with equity and precision to maximize public health impact.