What Will It Take to Reach the Fast Track Prevention Targets: What, Who and How

More than 15 000 participants attended the  21st International AIDS Conference in Durban from the 18 to 22 July 2016. Our health team organised a satellite entitled, What Will It Take to Reach the Fast Track Prevention Targets: What, Who and How, on behalf of the Bill and Melinda Gates Foundation. 

The world is embarking on a Fast Track strategy to end the AIDS epidemic by 2030. To accelerate progress towards ending the epidemic, new fast-track targets have been established: 90% of people living with HIV knowing their HIV status, 90% of people who know their status receiving treatment and 90% of people on HIV treatment having a suppressed viral load so their immune system remains strong and they are no longer infectious.

A session at the conference was organised by Genesis Analytic’s Health practice on behalf of the Bill and Melinda Gates Foundation. Panellists discussed what it would take to reach these targets. Shari Krishnaratne of the London School of Hygiene and Tropical Medicine presented the evidence for biomedical, behavioural and structural interventions for HIV prevention using a review of reviews methodology.

Though there are HIV prevention interventions in place, the impact of these interventions is not well understood because of a lack of data. HIV incidence is not collected as routine data and VMMC (voluntary male medical circumcision) data is only available after nine months (at the earliest). Consequently there isn’t a clear picture of the impact of existing HIV prevention interventions. Furthermore, there is the need for well-defined prevention indicators and clarity on how these indicators can be collected in order to achieve the prevention targets.

Linda-Gail Becker, Deputy Director of the Desmond Tutu Foundation, spoke strongly about the need to develop interventions for people who tested HIV negative. She said this was just as important as interventions for individuals who tested HIV positive.

Dr Saul Johnson, principal of the Health practice at Genesis, raised the issue of targeted interventions, explaining that most HIV interventions tried to do everything for everyone. He emphasised that interventions should rather focus on most at-risk populations to achieve maximum results. He reiterated the importance of moving our attention to HIV prevention, maintaining that “we cannot treat our way out of the epidemic”.

Women infected with HIV deserve our support

Dr Nduku Kilonzo, the head of the National AIDS Control Council in Kenya, supported by other panellists, said that in order to achieve the fast-track targets, prevention needed to be understood as a business model:  interventions which had previously worked in prevention, such as condoms, prevention of mother to child transmissions (PMTCT) and VMMC must be retained and strengthened while new interventions such as PrEP [pre-exposure prophylaxis] must be included in the model.

This view was reinforced by Karl Dehne from UNAIDS. He said: “Reaching the fast-track prevention targets is possible but it requires that we do business differently.” This business model would need to clearly identify targets, allocate finances to activities, appoint accountable parties, identify how equality assurance will be undertaken and finally address sustainability of HIV prevention interventions.

While great strides have been made in eliminating HIV, more work remained to be done to reach the fast-track prevention targets by 2020. The discussions which took place during the satellite are addressed in greater detail in articles in the latest HIV Lancet-Prevention edition.