Summary of exposure and outcome measures in studies using ecological measures to assess population-level effects of ART on HIV transmission.

<p>↑, upward trend; ↓, downward trend; →, stable rate. For studies using two exposure or outcome measures, two arrows are shown, corresponding to the measures listed first and second.</p><p>HAART, highly active ART; STD, sexually transmitted disease; VCT, voluntary counseling and testing; VL, viral load.</p

Analysis methods and conclusions regarding effects.

<p>CI, confidence interval; HAART, highly active ART; STI, sexually transmitted infection; VL, viral load.</p

Summary of measures used and considerations for their use.

<p>VL, viral load.</p

Estimated numbers of HIV-infected individuals in the US retained (and corresponding percentages lost) at various stages of the test, link, and treat cascade.

<p>This figure is based on data from <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001260#pmed.1001260-Gardner1" target="_blank">[61]</a>,<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001260#pmed.1001260-Burns1" target="_blank">[62]</a>.</p

The predicted effect of different levels of acute infection on a combination prevention package including universal testing and treatment, as will be tested in the PopART trial [20].

<p>(A) Green line: prevalence; red line: incidence. Two versions of a model are fitted to the adult HIV prevalence curve for South Africa (Joint United Nations Programme on HIV/AIDS): one “corrected” for serial monogamy effects in low-risk individuals <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001232#pmed.1001232-Cohen1" target="_blank">[5]</a>, and thus with a low contribution of AHI (solid line), and one without the correction, and thus with a high contribution of AHI (dashed line). Fitted parameters are as follows: the proportion of individuals in three risk groups (low, medium, and high), rate of partner change for high-risk individuals, assortativity of mixing by risk, start time, early treatment rates, and an overall infectiousness parameter. Other parameters were fixed from the literature <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001232#pmed.1001232-Cohen3" target="_blank">[13]</a>,<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001232#pmed.1001232-Gardner1" target="_blank">[14]</a>. (C) The intervention is introduced in 2012, and predictions are made until 2020, for three scenarios ranging from the very pessimistic (green line), through “just on target” (red line), to very optimistic (blue line). The results are surprisingly independent of the amount of transmission from AHI, as indicated by the solid versus dashed lines. (B and D) The contribution to transmission from individuals in different disease stages in the just-on-target scenarios is plotted in (B), corresponding to solid lines in (A) and (C) (corrected for serial monogamy effects), and (D), corresponding to dashed lines in (A) and (C) (not corrected for serial monogamy effects). Shown are all new infections of index cases in AHI and EHI (green), of index cases in untreated CHI (blue), and of index cases in treated CHI (red), as a proportion of total new infections.</p

HIV Care Continuum among HIV-infected female sex workers, Lilongwe, Malawi (n = 138).

<p>1A) Among all HIV-infected FSW; 1B) Among FSW achieving prior step. For Fig 1A, 69% (95/138) of all HIV-infected FSW had a history of care. Fifty-two percent (72/138) of all HIV-infected FSW reported current ART use and 45% (62/138) of all HIV-infected FSW were virally suppressed. For Fig 1B, 80% (111/138) of all HIV-infected FSW were previously diagnosed. While 86% (95/111) of FSW previously diagnosed had a history of HIV care. Seventy-six percent (72/95) of FSW with a history of HIV care reported current ART use. Eighty-six percent (62/72) of FSW reporting current ART use were virally suppressed.</p

Ongoing HIV Transmission and the HIV Care Continuum in North Carolina

<div><p>Objective</p><p>HIV transmission is influenced by status awareness and receipt of care and treatment. We analyzed these attributes of named partners of persons with acute HIV infection (index AHI cases) to characterize the transmission landscape in North Carolina (NC).</p><p>Design</p><p>Secondary analysis of programmatic data.</p><p>Methods</p><p>We used data from the NC Screening and Tracing of Active Transmission Program (2002–2013) to determine HIV status (uninfected, AHI, or chronic HIV infection [CHI]), diagnosis status (new or previously-diagnosed), and care and treatment status (not in care, in care and not on treatment, in care and on treatment) of index AHI cases' named partners. We developed an algorithm identifying the most likely transmission source among known HIV-infected partners to estimate the proportion of transmissions arising from contact with persons at different HIV continuum stages. We conducted a complementary analysis among a subset of index AHI cases and partners with phylogenetically-linked viruses.</p><p>Results</p><p>Overall, 358 index AHI cases named 932 partners, of which 218 were found to be HIV-infected (162 (74.3%) previously-diagnosed, 11 (5.0%) new AHI, 45 (20.6%) new CHI). Most transmission events appeared attributable to previously-diagnosed partners (77.4%, 95% confidence interval 69.4–85.3%). Among these previously-diagnosed partners, 23.2% (14.0–32.3%) were reported as in care and on treatment near the index AHI case diagnosis date. In the subset study of 33 phylogenetically-linked cases and partners, 60.6% of partners were previously diagnosed (43.9–77.3%).</p><p>Conclusions</p><p>A substantial proportion of HIV transmission in this setting appears attributable to contact with previously-diagnosed partners, reinforcing the need for improved engagement in care after diagnosis.</p></div

Model coefficients and corresponding predictor scores by HIV-1 subtype.

<p>Model coefficients and corresponding predictor scores by HIV-1 subtype.</p

Sensitivity and specificity of risk score models developed in the full and subtype-specific populations.

<p>The horizontal axes display all possible risk score cut-points that could be chosen for clinical implementation of a given algorithm. In clinical implementation, all persons with risk scores at or above a chosen cut-point would be identified as likely to subsequently have extended high viremia. Circles represent the proportion of all EHV cases with scores at or above a given risk score cut-point (i.e., sensitivity). Diamonds represent the proportion of all those who did not have EHV with scores below a given risk score cut-point (i.e., specificity).</p

Characteristics at enrollment^*.

<p>Characteristics at enrollment^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0192785#t001fn001" target="_blank">*</a>}.</p