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. T...