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Published in: Current HIV/AIDS Reports 4/2016

01-08-2016 | The Global Epidemic (SH Vermund, Section Editor)

The History of the HIV/AIDS Epidemic in Africa

Authors: Joseph Kagaayi, David Serwadda

Published in: Current HIV/AIDS Reports | Issue 4/2016

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Abstract

HIV testing of African immigrants in Belgium showed that HIV existed among Africans by 1983. However, the epidemic was recognized much later in most parts of sub-Saharan Africa (SSA) due to stigma and perceived fear of possible negative consequences to the countries’ economies. This delay had devastating mortality, morbidity, and social consequences. In countries where earlier recognition occurred, political leadership was vital in mounting a response. The response involved establishment of AIDS control programs and research on the HIV epidemiology and candidate preventive interventions. Over time, the number of effective interventions has grown; the game changer being triple antiretroviral therapy (ART). ART has led to a rapid decline in HIV-related morbidity and mortality in addition to prevention of onward HIV transmission. Other effective interventions include safe male circumcision, pre-exposure prophylaxis, and post-exposure prophylaxis. However, since none of these is sufficient by itself, delivering a combination package of these interventions is important for ending the HIV epidemic as a public health threat.
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71.•
go back to reference Hayes R et al. HPTN 071 (PopART): rationale and design of a cluster-randomised trial of the population impact of an HIV combination prevention intervention including universal testing and treatment—a study protocol for a cluster randomised trial. Trials. 2014;15:57. This paper describes the rationale and design of a trial to compare the population impact of three combination HIV prevention interventions in 21 communities in Zambia and South Africa including intervention 1 consisting of annual home-based HIV testing, promotion of medical male circumcision for HIV-negative men, and universal testing and treatment (UTT); intervention 2 consisting of everything in intervention 1 except that ART initiation will follow current national guidelines, and intervention 3 consisting being standard of care. Population cohorts of 2,500 adults will be randomly selected from each cluster and followed for 3 years to measure HIV incidence. Trial results, combined with modeling and cost data, will be used to assess the cost-effectiveness of UTT interventions. In addition, the three-arm design will enable assessment of how much could be achieved by optimal delivery of current policies and the costs and benefits of extending this to UTT. This trial will inform policies on scale-up of the WHO’s recommendations of test and “start.”.CrossRefPubMedPubMedCentral Hayes R et al. HPTN 071 (PopART): rationale and design of a cluster-randomised trial of the population impact of an HIV combination prevention intervention including universal testing and treatment—a study protocol for a cluster randomised trial. Trials. 2014;15:57. This paper describes the rationale and design of a trial to compare the population impact of three combination HIV prevention interventions in 21 communities in Zambia and South Africa including intervention 1 consisting of annual home-based HIV testing, promotion of medical male circumcision for HIV-negative men, and universal testing and treatment (UTT); intervention 2 consisting of everything in intervention 1 except that ART initiation will follow current national guidelines, and intervention 3 consisting being standard of care. Population cohorts of 2,500 adults will be randomly selected from each cluster and followed for 3 years to measure HIV incidence. Trial results, combined with modeling and cost data, will be used to assess the cost-effectiveness of UTT interventions. In addition, the three-arm design will enable assessment of how much could be achieved by optimal delivery of current policies and the costs and benefits of extending this to UTT. This trial will inform policies on scale-up of the WHO’s recommendations of test and “start.”.CrossRefPubMedPubMedCentral
Metadata
Title
The History of the HIV/AIDS Epidemic in Africa
Authors
Joseph Kagaayi
David Serwadda
Publication date
01-08-2016
Publisher
Springer US
Published in
Current HIV/AIDS Reports / Issue 4/2016
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI
https://doi.org/10.1007/s11904-016-0318-8

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