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Lancet HIV. 2018 Oct 9. pii: S2352-3018(18)30178-4. doi: 10.1016/S2352-3018(18)30178-4. [Epub ahead of print]

Defining control of HIV epidemics.

Author information

1
Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA. Electronic address: alison.galvani@yale.edu.
2
Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
3
Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
4
Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA.
5
Office of the President, South African Medical Research Council, Tygerberg, South Africa.

Abstract

Although the HIV pandemic remains a global crisis, much progress has been made in implementing programmes to treat and prevent HIV infection. To guide prioritisation of efforts, the metric by which a country can declare its HIV epidemic as controlled has become increasingly relevant. Herein, we evaluate the merits of the four control criteria proposed by UNAIDS: percentage reduction in incidence over time; ratio of incidence to mortality; ratio of incidence to prevalence; and annual incidence. Using a transmission model to generate projections of demography, incidence, and mortality, we highlight potential pitfalls associated with each of the first three criteria. A definition of control based on annual incidence would provide clarity and consistency across settings.

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