Week 9

• Prevention


  • CD4
  • T cell count
  • Viral load
  • Treatment begun
  • Undetectable
  • 50,000
• CD4 and viral load – progression after HIV infection
• Global evolution and spread
• Territory size proportionate to HIV prevalence 15-49 year olds

  • Territory size showing proportion of worldwide wealth (GDP)
• Adults and children estimated to be living with HIV 2022
• Estimated number of adults and children newly infected with HIV 2022
• New HIV diagnoses in NZ 1985-2022
• Estimated adult and child deaths from AIDS 2022
• Estimated number of deaths from AIDS, all ages 2000-2016 – all and by sex
• Change in new HIV infections and AIDS-related deaths by region 2010-2020
• Combination prevention


  • Treatment as Prevention (TasP)
  • Post-exposure Prophylaxis (PEP)
  • Pre-exposure prophylaxis (PrEP)
  • Medical male circumcision
  • Condoms
  • Needle exchange
  • Behaviour change
  • (New microbicides)
  • (Vaccines)
  • (Cure)
• Treatment as Prevention (TasP)

  • Modelling - Granich et al. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
  • Observational studies – KwaZulu-Natal, South Africa: Every % point increase in ART coverage among all HIV+ adults in a community was associated with a 1.7% decline in the hazard of HIV acquisition
• Near-normal expectancy for adults starting ART above 200 cells/µL
• 11.3 year gain in life expectancy in KZN, South Africa from 2003 (before ART became available in the public-sector health system), to 2011: 49.2 years – 60.5 years
• Treatment and Prevention


  Treatment as Prevention
• New HIV infections in low- and middle-income countries, 2010-2030: achievement of ambitious Fast-Track Targets compared to maintaining 2013 coverage
• AIDS-related deaths current and modelled no ARV scenario 1990–2022
• HIV testing and treatment cascade, global 2022
• Community


  • Testing: Mobile, Fixed Sites, Home-based, THP
  • Community Model of Care: Adherence Clubs, Community Adherence Groups
  • Early ART: <500, PMTCT B+
  • Decentralization, TB/HIV integration, NiMART, Mentoring support
  • Community mobilisation; condoms; MMC
• Home-based testing


  • ART initiation & follow-up
  • ANC/PMTCT
  • Paediatric care
  • TB/HIV integrated care
  • Decentralisation
  • Simplification
  • Task shifting
  • Clubs
  • Lay counselling
• Population-level outcomes 2013