New strategies for HIV surveillance in resource-constrained settings: an overview.

Additional funding recently became available to help resource-constrained countries scale up their HIV treatment and prevention activities. This increased funding is accompanied by an increased demand for accountability from stakeholders. Many countries will need to make substantial improvements in their current HIV surveillance methods to monitor the collective national impact of these treatment and prevention initiatives. However, whereas most resource-constrained countries have monitored the prevalence of HIV, they have collected little information on other events in the HIV disease process, such as HIV incidence, rate of HIV drug resistance, number of deaths due to AIDS and only modest emphasis has been placed on AIDS reporting in generalized epidemics, resulting in severe underreporting. In addition, data on mortality trends are often not gathered. Furthermore, less than half of the countries with low-level/concentrated epidemics have tailored their surveillance systems to the local epidemic, behavioral surveillance is often not present, an integrated analysis of data is not widespread, and data are rarely used to inform policy. In January 2004, a conference was convened in Addis Ababa, Ethiopia, to examine new strategies for surveillance in resource-constrained countries, and their use in monitoring and evaluating HIV activities. This supplement summarizes the newest approaches and lessons learned for HIV/AIDS surveillance, based on presentations and discussions from that conference. This article provides an overview of HIV/AIDS surveillance in resource-constrained settings and discusses the history, current approaches, and future directions for HIV/AIDS surveillance in generalized and low-level/concentrated epidemics

Epidemiological metrics and benchmarks for a transition in the HIV epidemic.

Peter Godfrey-Faussett and colleagues present six epidemiological metrics for tracking progress in reducing the public health threat of HIV

Knowing your HIV/AIDS epidemic and tailoring an effective response: how did India do it?

Tremendous global efforts have been made to collect data on the HIV/AIDS epidemic. Yet, significant challenges remain for generating and analysing evidence to allocate resources efficiently and implement an effective AIDS response. India offers important lessons and a model for intelligent and integrated use of data on HIV/AIDS for an evidence-based response. Over the past 15 years, the number of data sources has expanded and the geographical unit of data generation, analysis and use for planning has shifted from the national to the state, district and now subdistrict level. The authors describe and critically analyse the evolution of data sets in India and how they have been utilised to better understand the epidemic, advance policy, and plan and implement an increasingly effective, well-targeted and decentralised national response to HIV and AIDS. The authors argue that India is an example of how ‘know your epidemic, know your response’ message can effectively be implemented at scale and presents important lessons to help other countries design their evidence generation systems

How can we get close to zero? The potential contribution of biomedical prevention and the investment framework towards an effective response to HIV.

BACKGROUND: In 2011 an Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services resulting in a reduction of new HIV infections by more than half. However, it also estimated a leveling in the number of new infections at about 1 million annually after 2015. METHODS: We modeled how the response to AIDS can be further expanded by scaling up antiretroviral treatment (ART) within the framework provided by the 2013 WHO treatment guidelines. We further explored the potential contributions of new prevention technologies: 'Test and Treat', pre-exposure prophylaxis and an HIV vaccine. FINDINGS: Immediate aggressive scale up of existing approaches including the 2013 WHO guidelines could reduce new infections by 80%. A 'Test and Treat' approach could further reduce new infections. This could be further enhanced by a future highly effective pre-exposure prophylaxis and an HIV vaccine, so that a combination of all four approaches could reduce new infections to as low as 80,000 per year by 2050 and annual AIDS deaths to 260,000. INTERPRETATION: In a set of ambitious scenarios, we find that immediate implementation of the 2013 WHO antiretroviral therapy guidelines could reduce new HIV infections by 80%. Further reductions may be achieved by moving to a 'Test and Treat' approach, and eventually by adding a highly effective pre-exposure prophylaxis and an HIV vaccine, if they become available

A study of women\u27s preferences regarding the formulation of over-the-counter vaginal spermicides

There is an urgent need for safe, effective, and acceptable vaginal barrier methods for the prevention of sexually transmitted diseases (STDs), including HIV, and a variety of existing spermicides have the potential to be used for both prevention of STDs and unwanted pregnancy. Unfortunately, very little is known about formulation preferences and the desirable characteristics of vaginal preparations among the diverse populations of women who would potentially use these products. In this study, we explored vaginal spermicidal preparations containing nonoxynol-9 and the characteristics that influence user preferences for three formulations, as well as the risk of vaginal and cervical irritation associated with low-to-moderate use of products containing nonoxynol-9. The report recommends that formulation preferences of women be considered in the development and introduction of vaginal microbicides: the specific characteristics of vaginal products and their effect on sexual pleasure and communication will strongly determine the acceptability—and ultimately the use-effectiveness—of female-controlled STD-prevention methods

Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa

Background Previously, HIV epidemic models have used a double Weibull curve to represent high initial and late mortality of HIV-infected children, without distinguishing timing of infection (peri- or post-natally). With more data on timing of infection, which may be associated with disease progression, a separate representation of children infected early and late was proposed. Methods Paediatric survival post-HIV infection without anti-retroviral treatment was calculated using pooled data from 12 studies with known timing of HIV infection. Children were grouped into perinatally or post-natally infected. Net mortality was calculated using cause-deleted life tables to give survival as if HIV was the only competing cause of death. To extend the curve beyond the available data, children surviving beyond 2.5 years post infection were assumed to have the same survival as young adults. Double Weibull curves were fitted to both extended survival curves to represent survival of children infected perinatally or through breastfeeding. Results Those children infected perinatally had a much higher risk of dying than those infected through breastfeeding, even allowing for background mortality. The final-fitted double Weibull curves gave 75% survival at 5 months after infection for perinatally infected, and 1.1 years for post-natally infected children. An estimated 25% of the early infected children would still be alive at 10.6 years compared with 16.9 years for those infected through breastfeeding. Conclusions The increase in available data has enabled separation of child mortality patterns by timing of infection allowing improvement and more flexibility in modelling of paediatric HIV infection and surviva

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission\ud in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead\ud role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a\ud predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate\ud all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major\ud mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1