HIV: No time for complacency - South African AIDS Conference, Durban - 11 June 2019 - 10th SA AIDS Conference 2021
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
HIV: No time for complacency
South African AIDS Conference, Durban - 11 June 2019
Salim S. Abdool Karim, FRS
Director: CAPRISA
CAPRISA Professor of Global Health, Columbia University
Director: DST-NRF Centre of Excellence in HIV Prevention
Pro Vice-Chancellor (Research): University of KwaZulu-Natal
Associate, Ragon Institute of MGH, MIT and Harvard University
Adjunct Professor of Medicine, Cornell University
CAPRISA hosts a CAPRISA hosts a MRC HIV-TB Pathogenesis and
DST-NRF Centre ofCAPRISA is the UNAIDS CAPRISA hosts a DST- Treatment Research Unit CAPRISA hosts a MRC
Excellence in Collaborating Centre for CAPRISA is the UNAIDS Collaborating
NRF Centre of Excellence HIV-TB Pathogenesis and
CAPRISA hosts a DoH-MRC Special Initiative for
HIV Prevention HIV Research and Policy Centre for HIV Research and Policy in HIV Prevention HIV Prevention Technology
Treatment Research Unit
Overview
• Global HIV epidemic –
At a critical juncture - 3 major challenges
• UN 2030 goal: Ending AIDS as a public
health threat –
Is UTT or 90-90-90 the solution?
• HIV innovations and technologies -
To reach epidemic control…
The global HIV epidemic at a glance
In 2017, worldwide there were:
37 million living with HIV
5,000 new
HIV
940,000 HIV deaths infections
each day
1.8 million new infections
Source: UNAIDS Global Report 2018
Africa has 70% of all people with HIV
With
Great progress on increasing HIV
treatment but we are lagging in prevention
Number of people receiving antiretroviral
5% reduction in new infections 2013 - 2017
therapy, by WHO region, 2003–2017
25
21.7
People on Antiretroviral
19.5
20
therapy (millions)
17.1
15 2017
2017
15 12.9
10.9
10 9.1
7.5
5
0
2010 2011 2012 2013 2014 2015 2016 2017
Year
Even with 22 million on ART, much
has been done – but even more still
needs to be done!
Source: Global AIDS Response Progress Report.
3 major challenges – EECA, vulnerable sub-
groups (YBMSM in USA) & youth bulge in Africa
High HIV rates in vulnerable sub-groups
Increasing new such as young black MSM in US
HIV infections in
The youth bulge in Africa is increasing the number of adolescents and rates in young
women are still high. Hence, more HIV infections in young people in southern Africa
Number of
new HIV
Infections
in LMICs
(millions)
Sources: UNAIDS; CDC. HIV Surv Report 2018;29, UNAIDS Strategy 2016-2021 Abdool Karim Q, et al Sex Transm Infect 2014.
Overview
• UN 2030 goal: Ending AIDS as a public
health threat –
Is UTT or 90-90-90 the solution?
UN High Level Meeting – June 2016 • United Nations Secretary-General, Ban Ki-Moon, hosted a High Level Meeting on the global AIDS response at the UN in New York • The declaration adopted at the High Level Meeting defined the global response to HIV
UN Declaration
characterizes AIDS as “a
paramount health,
development, human
rights and social
challenge”
Member States committed
to end the AIDS epidemic
as a public health threat
by 2030, a key target for
the 2030 Agenda on
Sustainable Development,
adopted by the UN General
Assembly in 2015
Our chosen path to epidemic
control: 90-90-90
Compelling evidence
for treatment as
preventionWill the 90-90-90 UNAIDS targets achieve ending AIDS as a public health threat – ie. epidemic control?
Is Universal HIV Test & Treat (UTT) able
to achieve epidemic control in Africa?
Effect size (CI)
Botswana (Ya Tsie)
n=12,610 35% (10; 54)
SA, Zambia (PopART – B)
n=25,803 30% (12; 45)
SA, Zambia(PopART – A)
n=25,070 7% (-18; 26)
Kenya, Uganda (SEARCH)
n=150,395 5% (-17; 23)
South Africa (TasP)
n=28,419 -1 (-17-13)
-20 -10 0 10 20 30 40 50 60 70 80 90 100
Effectiveness (%)Status of adoption of WHO’s oral PrEP recommendation (as at June 2018)
Overview
•
• HIV innovations and technologies -
To reach epidemic control…Epidemic control - UN 2030 goal UN Political Declaration on HIV/AIDS Goal for 2030 - 90% decline in HIV incidence since 2010 The world is embarking on a Fast-Track strategy to end AIDS epidemic by 2030. To reach this visionary goal…countries will need to use the powerful tools available, hold one another accountable for results and make sure that no one is left behind.
New prevention technologies in
development and testing…
Monthly Annual Broadly
injectable sub-dermal HIV vaccines neutralising
antiretrovirals: implants antibodies
CAP256-VRC26.25
Cabotegravir Cabotegravir Mosiac CAP256, VRC07
Ripivirine TAF vaccine & PGT121
EFDANew treatment technologies in development and testing… Injectable Dual oral Xpert PoC maintenance therapy with Viral Load combo ARV Dolutegravir test Cabotegravir Dolutegravir Taqman vs Xpert - & Ripivirine & NRTI Good correlation
“…The AIDS response has now become a victim of its successes …. impression that the epidemic is no longer important or urgent. Commitment to HIV is slowly dissipating as the world’s attention shifts elsewhere. Complacency is setting in. However, nearly 5,000 new cases occur each day, defying any claim of a conquered epidemic. …no room for complacency when so much more remains to be done”
climbinga agreat
“Afterclimbing
“After greathill,
hill,one
oneonly
onlyfinds
finds
outthat
out thatthere
thereare
aremany
manymore
morehills
hillsto
toclimb”
climb”
(Nelson Mandela)You can also read
