Search

INTRODUCTION: To achieve significant progress in global HIV prevention from 2020 onward, it is essential to ensure that appropriate programmes are being delivered with high quality and sufficient intensity and scale and then taken up by the people who most need and want them in order to have both individual and public health impact. Yet, currently, there is no standard way of assessing this. Available HIV prevention indicators do not provide a logical set of measures that combine to show reduction in HIV incidence and allow for comparison of success (or failure) of HIV prevention programmes and for monitoring progress in meeting global targets. To redress this, attention increasingly has turned to the prospects of devising an HIV prevention cascade, similar to the now-standard HIV treatment cascade; but this has proven to be a controversial enterprise, chiefly due to the complexity of primary prevention. DISCUSSION: We address a number of core issues attendant with devising prevention cascades, including: determining the population of interest and accounting for the variability and fluidity of HIV-related risk within it; the fact that there are multiple HIV prevention methods, and many people are exposed to a package of them, rather than a single method; and choosing the final step (outcome) in the cascade. We propose two unifying models of prevention cascades-one more appropriate for programme managers and monitors and the other for researchers and programme developers-and note their relationship. We also provide some considerations related to cascade data quality and improvement. CONCLUSIONS: The HIV prevention field has been grappling for years with the idea of developing a standardised way to regularly assess progress and to monitor and improve programmes accordingly. The cascade provides the potential to do this, but it is complicated and highly nuanced. We believe the two models proposed here reflect emerging consensus among the range of stakeholders who have been engaging in this discussion and who are dedicated to achieving global HIV prevention goals by ensuring the most appropriate and effective programmes and methods are supported.

Phylogenetic analysis of pathogens is an increasingly powerful way to reduce the spread of epidemics, including HIV. As a result, phylogenetic approaches are becoming embedded in public health and research programmes, as well as outbreak responses, presenting unique ethical, legal, and social issues that are not adequately addressed by existing bioethics literature. We formed a multidisciplinary working group to explore the ethical issues arising from the design of, conduct in, and use of results from HIV phylogenetic studies, and to propose recommendations to minimise the associated risks to both individuals and groups. We identified eight key ethical domains, within which we highlighted factors that make HIV phylogenetic research unique. In this Review, we endeavoured to provide a framework to assist researchers, public health practitioners, and funding institutions to ensure that HIV phylogenetic studies are designed, done, and disseminated in an ethical manner. Our conclusions also have broader relevance for pathogen phylogenetics.

Introduction: Key populations (KP) continue to account for high HIV incidence globally. Still, prioritization of KP in the national HIV prevention response remains insufficient, leading to their suboptimal access to HIV programmes. This commentary aims to share Kenya's challenges and successes in achieving 2020 global HIV targets and scaling up the KP programme in the last decade. Discussion: The KP programme in Kenya has scaled up in the last decade with the inclusion of female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender people and people in prisons as priority populations in the national HIV response. KP coverage based on official size estimates for FSW is 73%, for MSM is 82%, for PWID through needle syringe programme (NSP) is 71%, and through opioid substitution therapy (OST) is 26% and for transgender people is 5%. The service outcomes for KP have been relatively strong in prevention with high condom use at last paid sex for FSW (92%) and use of sterile equipment among PWID (88%), though condom use at last sex with a non-regular partner among MSM (78%) is still low. The KP programme has not met care continuum targets for all subpopulations with low case findings. The national KP programme led by the Ministry of Health has scaled up the programme through (a) strategic partnerships with KP-led and competent organizations, researchers and donors; (b) development of policy guidance and programme standards; (c) continuous sensitization and advocacy to garner support; (d) development of national reporting systems, among others. However, the programme is still struggling with uncertain size estimates; lack of updated bio-behavioural survey data; inadequate scale-up of interventions among transgender people and people in prison settings; gaps in reaching adolescent and young KP, and effectively addressing structural barriers like violence and stigma. Conclusions: To reach the ambitious global HIV targets, sufficient coverage of KP with quality HIV programmes is critical. Despite scaling up the KP programme, Kenya has not yet achieved the 2020 global HIV targets and needs more efforts to scale-up quality programmes for KP who are underserved in the HIV response. Keywords: key populations; scale; 2020 global HIV targets; Kenya; HIV programmes, 1 | INTRODUCTION New HIV infections in Kenya have fallen from 75,000 among adults in 2010 to 41,416 in 2019 [1]. To continue this trend, the provision of prevention services [...]

The World Health Organization (WHO) set targets for a 90% reduction in the incidence of syphilis and gonorrhoea between 2018 and 2030. We review trends in sexually transmitted infections in the WHO South-East Asia Region to assess the feasibility of reaching these targets. Myanmar, Sri Lanka and Thailand reported 90% or greater reductions in the incidence or prevalence of syphilis and/or gonorrhoea between 1975 and 2005. Evidence suggests that smaller, more recent reductions in trends in sexually transmitted infections in India have driven regional declines. In other countries, sexually transmitted infections remain high or are increasing or data are not reliable enough to measure change. Sri Lanka and Thailand have strong control programmes for sexually transmitted infections that ensure universal access to services for these infections and targeted interventions in key populations. India and Myanmar have implemented targeted control efforts on a large scale. Other countries of the region have prioritized control of human immunodeficiency virus, and limited resources are available for other sexually transmitted infections. At national and subnational levels, data show rapid declines in sexually transmitted infections when targeted promotion of condom use and sexually transmitted infection services are scaled up to reach large numbers of sex workers. In contrast, recent outbreaks of sexually transmitted infections in underserved populations of men who have sex with men have been linked to rising trends in sexually transmitted infections in the region. A renewed and focused response to sexually transmitted infections in the region is needed to meet global elimination targets. L'Organisation mondiale de la Sante (OMS) a fixe des objectifs pour reduire a 90% l'incidence de la syphilis et de la gonorrhee entre 2018 et 2030. Nous avons etudie les tendances en matiere d'infections sexuellement transmissibles dans la Region d'Asie du Sud-Est de l'OMS afin d'evaluer la faisabilite de ces objectifs. Le Myanmar, le Sri Lanka et la Thailande ont signale une diminution de 90% ou plus dans l'incidence ou la prevalence de la syphilis et/ou de la gonorrhee entre 1975 et 2005. Les donnees semblent indiquer une tendance a la baisse plus recente et moins significative des infections sexuellement transmissibles en Inde, entrainant une decrue regionale. Dans d'autres pays, soit le nombre d'infections sexuellement transmissibles demeure eleve ou continue sa progression, soit les informations disponibles ne sont pas suffisamment fiables pour en mesurer l'evolution. Le Sri Lanka et la Thailande ont etabli de solides programmes de lutte contre les infections sexuellement transmissibles, permettant d'acceder a des services specialement concus pour leur prise en charge et prevoyant une intervention ciblee au sein des populations cles. De leur cote, l'Inde et le Myanmar ont deploye des efforts a grande echelle afin de mener des actions ciblees. D'autres pays de la region ont privilegie la lutte contre le virus de l'immunodeficience humaine; pour les autres infections sexuellement transmissibles, leurs ressources sont limitees. Aux niveaux national et infranational, les donnees revelent un rapide declin des infections sexuellement transmissibles lorsque la promotion ciblee pour encourager l'usage du preservatif et les services dedies a la prise en charge de telles affections sont renforces afin de toucher un plus grand nombre de travailleurs du sexe. En revanche, les epidemies d'infections sexuellement transmissibles observees dernierement au sein de populations defavorisees d'hommes ayant des relations sexuelles avec d'autres hommes ont entraine une hausse dans la region. Il est donc indispensable d'apporter une reponse remaniee et ciblee face aux infections sexuellement transmissibles dans la region en vue d'atteindre les objectifs mondiaux d'elimination. La Organizacion Mundial de la Salud (OMS) fijo como objetivo una reduccion del 90% en la incidencia de la sifilis y la gonorrea entre 2018 y 2030. Revisamos las tendencias de las infecciones de transmision sexual en la Region del Sudeste Asiatico de la OMS para evaluar la viabilidad de alcanzar estos objetivos. Myanmar, Sri Lanka y Tailandia informaron de reducciones del 90% o mas en la incidencia o prevalencia de sifilis y/o gonorrea entre 1975 y 2005. Los datos sugieren que las reducciones mas pequenas y recientes en las tendencias de las infecciones de transmision sexual en la India han impulsado los descensos regionales. En otros paises, las infecciones de transmision sexual siguen siendo elevadas o estan aumentando, o los datos no son lo suficientemente fiables como para medir el cambio. Sri Lanka y Tailandia tienen solidos programas de control de las infecciones de transmision sexual que garantizan el acceso universal a los servicios para estas infecciones e intervenciones especificas en poblaciones clave. India y Myanmar han implementado esfuerzos de control especificos a gran escala. Otros paises de la region han dado prioridad a la lucha contra el virus de la inmunodeficiencia humana y disponen de recursos limitados para otras infecciones de transmision sexual. A nivel nacional y subnacional, los datos muestran un rapido descenso de las infecciones de transmision sexual cuando se amplia la promocion del uso del preservativo y los servicios para las infecciones de transmision sexual para llegar a un gran numero de profesionales del ambito sexual. Por el contrario, los recientes brotes de infecciones de transmision sexual en poblaciones desatendidas de hombres que tienen relaciones sexuales con otros hombres se han relacionado con las tendencias al alza de las infecciones de transmision sexual en la region. Se necesita una respuesta renovada y centrada en las infecciones de transmision sexual en la region para alcanzar los objetivos mundiales de eliminacion., Introduction The World Health Organization's (WHO's) global health-sector strategy on sexually transmitted infections (2016-2021) has set targets for 90% reductions in the incidence of Treponema pallidum (syphilis) and Neisseria gonorrhoeae [...]

: Introduction: Globally, over half of the estimated new HIV infections now occur among key populations, including men who have sex with men, sex workers, people who inject drugs, transgender individuals, and people in prisons and other closed settings, and their sexual partners. Reaching epidemic control will, for many countries, increasingly require intensified programming and targeted resource allocation to meet the needs of key populations and their sexual partners. However, insufficient funding, both in terms of overall amounts and the way the funding is spent, contributes to the systematic marginalization of key populations from needed HIV services. Discussion: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently highlighted the urgent need to take action to end inequalities, including those faced by key populations, which have only been exacerbated by the COVID‐19 pandemic. To address these inequalities and improve health outcomes, key population programs must expand the use of a trusted access platform, scale up differentiated service delivery models tailored to the needs of key populations, rollout structural interventions and ensure service integration. These critical program elements are often considered “extras,” not necessities, and consequently costing studies of key population programs systematically underestimate the total and unitary costs of services for key populations. Findings from a recent costing study from the LINKAGES project suggest that adequate funding for these four program elements can yield benefits in program performance. Despite this and other evidence, the lack of data on the true costs of these elements and the costs of failing to provide them prevents sufficient investment in these critical elements. Conclusions: As nations strive to reach the 2030 UNAIDS goals, donors, governments and implementers should reconsider the true, but often hidden costs in future healthcare dollars and in lives if they fail to invest in the community‐based and community‐driven key population programs that address structural inequities. Supporting these efforts contributes to closing the remaining gaps in the 95‐95‐95 goals. The financial and opportunity cost of perpetuating inequities and missing those who must be reached in the last mile of HIV epidemic control must be considered., INTRODUCTION Globally, over half of the estimated new HIV infections now occur among key populations, including men who have sex with men (MSM), sex workers, people who inject drugs, transgender [...]

: Introduction: To achieve significant progress in global HIV prevention from 2020 onward, it is essential to ensure that appropriate programmes are being delivered with high quality and sufficient intensity and scale and then taken up by the people who most need and want them in order to have both individual and public health impact. Yet, currently, there is no standard way of assessing this. Available HIV prevention indicators do not provide a logical set of measures that combine to show reduction in HIV incidence and allow for comparison of success (or failure) of HIV prevention programmes and for monitoring progress in meeting global targets. To redress this, attention increasingly has turned to the prospects of devising an HIV prevention cascade, similar to the now‐standard HIV treatment cascade; but this has proven to be a controversial enterprise, chiefly due to the complexity of primary prevention. Discussion: We address a number of core issues attendant with devising prevention cascades, including: determining the population of interest and accounting for the variability and fluidity of HIV‐related risk within it; the fact that there are multiple HIV prevention methods, and many people are exposed to a package of them, rather than a single method; and choosing the final step (outcome) in the cascade. We propose two unifying models of prevention cascades‐one more appropriate for programme managers and monitors and the other for researchers and programme developers‐and note their relationship. We also provide some considerations related to cascade data quality and improvement. Conclusions: The HIV prevention field has been grappling for years with the idea of developing a standardised way to regularly assess progress and to monitor and improve programmes accordingly. The cascade provides the potential to do this, but it is complicated and highly nuanced. We believe the two models proposed here reflect emerging consensus among the range of stakeholders who have been engaging in this discussion and who are dedicated to achieving global HIV prevention goals by ensuring the most appropriate and effective programmes and methods are supported., INTRODUCTION The UN Political Declaration of 2016 outlined key 2020 Global Prevention Targets and Commitments that included reducing the numbers of people newly infected with HIV to fewer than 500,000 [...]

Introduction There have been substantial gains in the range and efficacy of technologies available for HIV prevention, with voluntary medical male circumcision (VMMC), treatment as prevention, and pre‐exposure prophylaxis (PrEP) [...]

This paper seeks to outline the key elements of the expanded surveillance efforts recommended by the second-generation HIV surveillance approach. Second-generation systems focus on improving and expanding existing surveillance methods and combine them in ways that have the greatest explanatory power. The main elements of this approach include: considering biological surveillance - HIV, AIDS, sexually transmitted infections (STIs) - and behavioural surveillance as integral components, targeting surveillance efforts at segments of the population where most new infections are concentrated - which might differ depending on the stage and type of the epidemic - and providing the rationale for the optimal use of data generated for monitoring the HIV epidemic and evaluating national AIDS control programmes. The paper emphasizes improvements in existing surveillance methodologies and discusses in detail crucial issues such as the validity of HIV prevalence data measured in pregnant women and linking HIV surveillance and behavioural data collection. In addition, a strategic partnership between second-generation surveillance and AIDS programme evaluation is proposed that stresses the complementary roles of these data collection activities in determining the effectiveness of prevention and care programmes and explaining the epidemiological trend data collected by sentinel serosurveillance systems. In conclusion, second-generation HIV surveillance systems provide a comprehensive, cost-effective and appropriate response to the information needs of AIDS control programmes. The implementation of such systems, including a better use of the data generated by the system, will ensure that national programmes are in the best possible position to respond to the challenges of the epidemic.

Research has been conducted on sexually transmitted infection and HIV infection prevention in Kenyan youth. The vulnerability of young adults to HIV infection and the need of intensive intervention in this group have been investigated, and the results demonstrate that the low condom use and little knowledge of these infections indicate the importance of HIV prevention programs for this group of people.