Data from: How can we get close to zero?: the potential contribution of biomedical prevention and the investment framework towards an effective response to HIV

Background: In 2011 an Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services resulting in a reduction of new HIV infections by more than half. However, it also estimated a leveling in the number of new infections at about 1 million annually after 2015. Methods: We modeled how the response to AIDS can be further expanded by scaling up antiretroviral treatment (ART) within the framework provided by the 2013 WHO treatment guidelines. We further explored the potential contributions of new prevention technologies: ‘Test and Treat’, pre-exposure prophylaxis and an HIV vaccine. Findings: Immediate aggressive scale up of existing approaches including the 2013 WHO guidelines could reduce new infections by 80%. A ‘Test and Treat’ approach could further reduce new infections. This could be further enhanced by a future highly effective pre-exposure prophylaxis and an HIV vaccine, so that a combination of all four approaches could reduce new infections to as low as 80,000 per year by 2050 and annual AIDS deaths to 260,000. Interpretation: In a set of ambitious scenarios, we find that immediate implementation of the 2013 WHO antiretroviral therapy guidelines could reduce new HIV infections by 80%. Further reductions may be achieved by moving to a ‘Test and Treat’ approach, and eventually by adding a highly effective pre-exposure prophylaxis and an HIV vaccine, if they become available.

背景：2011年，研究人员提出一项艾滋病投资框架，阐述了扩大关键HIV干预措施规模的路径，以期在2015年前大幅降低中低收入国家的新增HIV感染病例与艾滋病死亡人数。该框架设定了预防与治疗服务的雄心勃勃的覆盖目标，计划将新增HIV感染人数削减一半以上。但该框架同时预估，2015年后每年新增感染人数将进入平台期，维持在约100万的水平。

方法：本研究基于2013年世界卫生组织（World Health Organization, WHO）治疗指南确立的框架，通过扩大抗逆转录病毒治疗（antiretroviral treatment, ART）的覆盖规模，构建模型分析了艾滋病防控措施的进一步拓展路径。此外，本研究还探讨了四类新型预防技术的潜在贡献：检测即治疗（Test and Treat）、暴露前预防（pre-exposure prophylaxis, PrEP）以及HIV疫苗。

结果：即刻积极推进现有干预手段（包括2013年WHO治疗指南框架下的方案）的规模扩面，可使新增HIV感染人数降低80%。采用“检测即治疗”策略可进一步减少新增感染病例。若结合未来研发成功的高效暴露前预防手段与HIV疫苗，这一防控效果还可得到进一步增强——四种干预手段联用，可在2050年将每年新增HIV感染人数降至仅8万，同时将每年艾滋病死亡人数控制在26万以内。

解读：在一系列雄心勃勃的模拟场景中，本研究发现，即刻落实2013年WHO抗逆转录病毒治疗指南，可使新增HIV感染人数降低80%。若进一步采用“检测即治疗”策略，乃至在相关技术问世后引入高效暴露前预防手段与HIV疫苗，还可实现更为显著的感染人数降幅。