Declines but Not a Decisive Effect of the Intervention

UNAIDS’ Fast-Track Goals for ending the epidemic focused on testing 90 percent of people living with HIV, linking 90 percent of those people to ART, and supporting 90 percent of those individuals to reach virologic suppression. This busy figure summarizes recent research on how reaching these targets impacts incidence.

Each orange arrow shows the level of virologic suppression among PLHIV in the community at the start and end of the trial, the pairs of arrows represent different trial arms. The figure in the box above is the absolute difference in suppression between the two arms. For PopART, which had three arms, there are two different comparisons. The longer arrows belong to the intervention arms, which had a greater increase in virologic suppression across the trials. The blue bars show the point estimate for, and confidence interval around, the relative incidence in the intervention arm compared to the control arm. The bottom line: arms with community-wide testing saw incidence drop. Rapid expansion of ART leading to virologic suppression is feasible. This is good news for communities and individuals.

Excerpted from AVAC Report 2019: Now What?

A Generic and Unifying HIV Prevention Cascade Framework

What get’s measured matters if and only if that measurement is linked to impact. The most common approaches to evaluating primary prevention don’t measure up. They measure commodities but not use. A count of the condoms or PrEP bottles handed to people does not tell you whether the condoms were used, the pills were taken—or even, often, whether the people receiving the commodities were at high risk of HIV. A simple, universal prevention cascade could help change that. This one, which presumes that HIV testing has happened and is focused on people at risk of HIV, suggests four stages (see A) and then shows how solutions could be tailored to fix the cascade (see B).

Excerpted from AVAC Report 2019: Now What?

Visualizing Multisectoral Prevention: The DREAMS program theory of change

This is PEPFAR’s own visualization of how its AGYW programs can effect change. It’s notable for the definition of a care package that touches on the individual and her community, and for the way it defines a range of outcomes. There isn’t anything comparable for PEPFAR’s Key Population Investment Fund, which is infusing resources into a range of countries. Some of that funding is going for ART; for primary prevention, a theory of change linked to incidence is a must. AVAC is working with allies in KPIF countries to make this demand.

Excerpted from AVAC Report 2019: Now What?

Monitoring Primary Prevention: What to look at and why it matters – for oral PrEP and more

A look at four major factors relevant to primary prevention and correlated interventions to support their impact.

Excerpted from AVAC Report 2019: Now What?

What Gets Measured Matters

There is enormous variability in country and funder/normative approaches to tracking PrEP program rollout. Assessments of progress require common, comprehensive measures against and estimates of the parameters seen here.

Excerpted from AVAC Report 2019: Now What?

Total and Additional Users of Modern Contraception, 2012-2019

In November 2019, FP2020 released Women at the Center: 2018-2019, its latest progress report from which this graphic is adapted. As its graphic below shows, coverage of modern contraception in the 69 low-income countries that partner with FP2020 in tracking progress has increased since 2012, but not at the pace needed to meet the FP2020 goal. The group has also launched a post-2020 vision, and AVAC looks forward to working together towards an integration agenda.

Excerpted from AVAC Report 2019: Now What?

Metrics for Epidemic Transition: A glossary

Following the 2016 UN High-Level Meeting on HIV/AIDS, UNAIDS undertook work to derive a better definition of what “epidemic control” might look like and how it might be measured. It turns out that out saying the era of seeking the “end of the AIDS epidemic”—a phrase from a few years back—has come to an end. It’s rhetorically powerful but tricky to pin down what this means. Countries and communities need better, more precise ways to track progress. Funders need this information too, in order to see impact and sustain confidence in the effort. With great global diversity in incidence and mortality rates, worldwide measures obscure progress and challenges.

This table summarizes the work to date on identifying metrics that make sense for tracking the epidemic. Civil society must weigh in on what matters to us, which of these terms is meaningful and how to minimize the potential for manipulation and misinterpretation.

Excerpted from AVAC Report 2019: Now What?

Universal Test and Treat (UTT) Trial Results

As this table shows, the two trials that offered community-wide testing in both arms (SEARCH, TasP) did not find a difference in incidence between the arms. One explanation may be that the expanded access to testing and linkage in both arms had an impact in both intervention and control communities. The two trials that only provided universal testing in the intervention arm identified differences in incidence between that arm and the control arm.

There were other differences between the four UTT trials. As described below, PopART was the only trial with urban and peri-urban communities.

Excerpted from AVAC Report 2019: Now What?

AVAC Report 2019: Now What?

Each year, the AVAC Report frames the most pressing advocacy issues facing the HIV response. At the threshold of 2020, it’s clear that global goals for HIV prevention will miss the mark by a long shot. Though important progress has been made, the crisis UNAIDS called out in 2016 persists today with new infections around 1.7 million annually, a far cry from the 2020 target of fewer than 500,000. So, we asked ourselves, Now What?, and answered with cross-cutting analysis and an advocacy agenda to match.

For more from the report, including a link to all its graphics, visit report.avac.org. A one-pager of AVAC’s 2020 priorities is also available.

The Dapivirine Ring: Key learnings from like-product introductions

Vaginal insertion and partial efficacy are two challenges that could affect the uptake and continued use of the dapivirine ring. Analyses of the introductions of other products that share similar characteristics provide useful lessons to inform planning for rollout of the dapivirine ring. This paper provides information for planners, implementers, funders, researchers, trainers, providers of technical assistance and others to build an agenda for introducing the dapivirine ring that addresses these two challenges.