Epidemiological metrics and benchmarks for a transition in the HIV epidemic

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 27 Oct 2018 )

Perspective
Epidemiological metrics and benchmarks for a transition in the HIV epidemic
Peter D. Ghys, Brian G. Williams, Mead Over, Timothy B. Hallett, Peter Godfrey-Faussett
| published 25 Oct 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002678
Introduction
The goal of ‘Ending the AIDS epidemic as a public health threat by 2030’ has been reflected in the Sustainable Development Goals (SDGs), and similar language has been adapted for other diseases and conditions [1]. Between 2010 and 2017, the number of AIDS-related deaths has declined by 34%, and the number of new HIV infections has declined by 18% [2]. Although these declines constitute important achievements, progress has been slower than envisaged, which is likely due to a combination of suboptimal or inappropriate policies, lack of funding, limited or misdirected implementation of available strategies and tools, or other obstacles. Metrics and corresponding target values or benchmarks that demonstrate progress in the AIDS response and its effect on the AIDS epidemic are useful as the world heads towards that goal.

‘Ending the AIDS epidemic’ has not been defined in scientific terms, and it can be seen as a global aspiration in a distant future. Elimination of all new infections does not appear possible in the short and medium term with the tools available today. Metrics that signal medium-term progress and can be applied in countries, subnational entities, and population groups may be particularly valuable, as they can allow for local accountability and target-driven programme management. Achieving a certain benchmark would then herald the gradual reduction in the HIV burden in that community and could help lay the groundwork for a push to end the epidemic. The benchmarks for the metrics discussed in this paper should not be seen as indicative of tipping points, as those are unlikely to exist in the real world for an infection with a long incubation period and with survival being extended by antiretroviral treatment. Rather, they can be seen as important achievements in the management of epidemics…