Correction: What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach.

[This corrects the article DOI: 10.1371/journal.pone.0154893.].

Correction: What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach.

[This corrects the article DOI: 10.1371/journal.pone.0154893.].

What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach.

In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually-far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US$7.4Bn in low-income countries, US$8.2Bn in lower middle-income countries and US$10.5Bn in upper-middle-income-countries by 2020 before declining approximately 9% by 2030.

Protecting HIV information in countries scaling up HIV services: a baseline study.

BACKGROUND: Individual-level data are needed to optimize clinical care and monitor and evaluate HIV services. Confidentiality and security of such data must be safeguarded to avoid stigmatization and discrimination of people living with HIV. We set out to assess the extent that countries scaling up HIV services have developed and implemented guidelines to protect the confidentiality and security of HIV information. METHODS: Questionnaires were sent to UNAIDS field staff in 98 middle- and lower-income countries, some reportedly with guidelines (G-countries) and others intending to develop them (NG-countries). Responses were scored, aggregated and weighted to produce standard scores for six categories: information governance, country policies, data collection, data storage, data transfer and data access. Responses were analyzed using regression analyses for associations with national HIV prevalence, gross national income per capita, OECD income, receiving US PEPFAR funding, and being a G- or NG-country. Differences between G- and NG-countries were investigated using non-parametric methods. RESULTS: Higher information governance scores were observed for G-countries compared with NG-countries; no differences were observed between country policies or data collection categories. However, for data storage, data transfer and data access, G-countries had lower scores compared with NG-countries. No significant associations were observed between country score and HIV prevalence, per capita gross national income, OECD economic category, and whether countries had received PEPFAR funding. CONCLUSIONS: Few countries, including G-countries, had developed comprehensive guidelines on protecting the confidentiality and security of HIV information. Countries must develop their own guidelines, using established frameworks to guide their efforts, and may require assistance in adapting, adopting and implementing them.

The cost of treatment and care for people living with HIV infection: implications of published studies, 1999-2008.

PURPOSE OF REVIEW: Increasing number of people living with HIV (PLHIV) will require expanded access to health services. Countries need robust and contemporary strategic information on the cost of care to monitor and evaluate the effectiveness, efficiency, equity, and acceptability of services. Published HIV cost literature from July 1999 to December 2008 was reviewed. Articles were identified using specific databases and scored, based on explicit criteria relating to the services covered, utilization data, cost data used and quality of the study. RECENT FINDINGS: One hundred and fifteen articles were identified, 47% came from North America, 29% from Europe, 17% from Africa and 8% from Asia; no studies from Latin America could be identified. The mean score across all studies was 33.7 out of a maximum of 64, with a median of 34 and a range of 11-51. Mean score did not change significantly over time (Pearson's R8 = 0.3; P > 0.05). SUMMARY: Great variation was observed in the methods used to estimate cost data across the studies identified, including range of services, patients covered and outcomes costed. Progress in the quantity and quality of studies published since 1999 has been limited. More consistent costing methods and more comprehensive coverage - both by country and level of care - are needed in order for policymakers and other stakeholders to be able to optimally monitor and evaluate the cost and cost-effectiveness of country services for HIV treatment and care, especially as population costs are likely to increase with more PLHIV on antiretroviral therapy.

Why and how to monitor the cost and evaluate the cost-effectiveness of HIV services in countries.

The number of people in the world living with HIV is increasing as HIV-related mortality has declined but the annual number of people newly infected with HIV has not. The international response to contain the HIV pandemic, meanwhile, has grown. Since 2006, an international commitment to scale up prevention, treatment, care and support services in middle and lower-income countries by 2010 has been part of the Universal Access programme, which itself plays an important part in achieving the Millennium Development Goals by 2015. Apart from providing technical support, donor countries and agencies have substantially increased their funding to enable countries to scale up HIV services. Many countries have been developing their HIV monitoring and evaluation systems to generate the strategic information required to track their response and ensure the best use of the new funds. Financial information is an important aspect of the strategic information required for scaling up existing services as well as assessing the effect of new ones. It involves two components: tracking the money available and spent on HIV at all levels, through budget tracking, national health accounts and national AIDS spending assessments, and estimating the cost and efficiency of HIV services. The cost of service provision should be monitored over time, whereas evaluations of the cost-effectiveness of services are required periodically; both should be part of any country's HIV monitoring and evaluation system. This paper provides country examples of the complementary relationship between monitoring the cost of HIV services and evaluating their cost-effectiveness. It also summarizes global initiatives that enable countries to develop their own HIV monitoring and evaluation systems and to generate relevant, robust and up-to-date strategic information.

How Uganda reversed its HIV epidemic.

Uganda is one of only two countries in the world that has successfully reversed the course of its HIV epidemic. There remains much controversy about how Uganda's HIV prevalence declined in the 1990s. This article describes the prevention programs and activities that were implemented in Uganda during critical years in its HIV epidemic, 1987 to 1994. Multiple resources were aggregated to fuel HV prevention campaigns at multiple levels to a far greater degree than in neighboring countries. We conclude that the reversed direction of the HIV epidemic in Uganda was the direct result of these interventions and that other countries in the developing world could similarly prevent or reverse the escalation of HIV epidemics with greater availability of HIV prevention resources, and well designed programs that take efforts to a critical breadth and depth of effort.

Gender and monitoring the response to HIV / AIDS pandemic.

The mechanisms, techniques, and data sources used to monitor and evaluate global AIDS prevention and treatment services may vary according to gender. The Joint United Nations Programme on HIV / AIDS has been charged with tracking the response to the pandemic by using a set of indicators developed as part of the Declaration of Commitment endorsed at the U.N. General Assembly Special Session on AIDS in 2001. Statistics on prevalence and incidence indicate that the pandemic has increasingly affected women during the past decade. Women's biologic, cultural, economic, and social status can increase their likelihood of becoming infected with HIV.