Research Article: Setting targets for HIV/AIDS—What lessons can be learned from other disease control programmes?

Date Published: February 4, 2019

Publisher: Public Library of Science

Author(s): Tazeem Bhatia, Jamie Enoch, Mishal Khan, Sophie Mathewson, David Heymann, Richard Hayes, Osman Dar

Abstract: In a Collection Review, Richard Hayes and colleagues discuss metrics for assessing progress in control of the HIV/AIDS epidemic in the context of prior disease control programmes.

Partial Text: Over the last four decades, efforts to address the global HIV pandemic have required multidisciplinary and multisectoral approaches adapted to different contexts [1]. The complex epidemiology of HIV and the breadth of scientific, societal, and political stakeholders involved in the global response have posed challenges in terms of coordination, harmonisation, and funding. Concerted advocacy and successive global strategies to prevent and control HIV have had a major influence on the global availability of political and financial support and on national response strategies [2]. However, the campaign against HIV highlights both the importance of globally agreed definitions and the challenges of developing a common understanding of overarching goals, targets, and measures of progress.

In 1955, the World Health Assembly (WHA) adopted a Global Malaria Eradication Campaign (GMEP) involving indoor spraying with dichlorodiphenyltrichloroethane (DDT) and treatment of malaria [34]. Eradication was defined as the ‘global extinction’ of the parasite [35].

Both leprosy and HIV/AIDS are chronic rather than acute infectious diseases, requiring long-term management and treatment, and disproportionately affecting marginalised groups. However, leprosy differs from HIV in that multidrug therapy (MDT) cures leprosy infection and can be discontinued, while HIV requires lifelong treatment to suppress, not cure, infection.

Following the Second World War, industrialised countries witnessed rapid declines in TB incidence of approximately 10% per year [62] associated with socioeconomic development, including reductions in overcrowding and improved living conditions, nutrition, and hygiene [63]. Effective TB control was further aided by the advent of chemotherapy, universal access to healthcare in many countries, and TB-specific vertical programmes.

Early in the HIV/AIDS epidemic, there were limited targets at the global level. These have since developed into increasingly numerous, complex target frameworks. This section briefly summarises different HIV targets at the global level, omitting the many specific national- and community-level targets.

Several important lessons emerge from our analysis that should be considered in developing future goals and targets for HIV control.



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