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. Now what?
This is a one-pager summarizing AVAC’s priorities for 2020. To download the full Report or see all its graphics, visit report.avac.org.
This infographic lays out AVAC’s top-line recommendations from AVAC Report 2019: Now What? The recommendations fall into three categories: deliver — prevention programs whose impact is well-measured and -defined; demonstrate — next-generation engagement for next-generation trials; develop — new targets for the post-2020 world.
The most widely-known UNAIDS Fast-Track goals were the 90-90-90 targets focused on diagnosing people with HIV, linking them to ART and supporting them to achieve virologic suppression. But these were only part of what the UNAIDS modelers said was needed to reduce new HIV diagnoses to 500,000 per year; the model also included significant scaling up of primary prevention including the targets listed below. There are gaps across the board, which helps explain how the world fell short of the hoped-for reduction in new HIV diagnoses.
Excerpted from AVAC Report 2019: Now What?
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?
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?
A look at four major factors relevant to primary prevention and correlated interventions to support their impact.
Excerpted from AVAC Report 2019: Now What?
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?
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?
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?
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?