We are committed to using implementation science to find solutions to ending the HIV epidemic in these priority areas:
Health-Related Quality of Life
The development of highly effective medications for HIV treatment has led to substantial improvements in clinical and virologic outcomes for people living with HIV. For example, an overwhelming amount of clinical evidence shows that people living with HIV cannot sexually transmit the virus to partners once they are virally suppressed, that is, by taking and adhering to antiretroviral therapy as prescribed.
Despite these impressive gains a good health-related quality of life is not being achieved for some. Many people living with HIV and ageing with HIV experience poor health-related quality of life with regards to their mental, sexual and physical wellbeing.
Suboptimal health-related quality of life is driven be several factors including stigma, comorbidities, relationship challenges, social circumstances and structural inequalities. There is also evidence that gender differences exist in health-related quality of life among people living with HIV. We are committed to achieving the 4th 90 by identifying and implementing solutions that improves health-related quality of life.
Stigma & Discrimination
To end the AIDS epidemic by 2030, we believe that HIV-related stigma and discrimination must be eliminated. HIV-related stigma and discrimination negatively impact testing, uptake and use of treatment and prevention methods, deter health-seeking behaviours, hinder prevention efforts and linkage to care and support, and disrupt HRQoL for people living with HIV.
Stigma is driven by lack of HIV knowledge, cultural and gender norms, economic inequalities, laws and regulations, and many more factors. Some individuals experience intersectional stigma due to prejudices related to their affiliations to multiple stigmatized identities.
High rates of HIV-related stigma and discrimination persist despite considerable efforts to combat it. We believe that implementation science is critical to the elimination of HIV-related stigma and discrimination.
Before new HIV drugs were made available in 1996, life expectancy for individuals with HIV was 18 months post the onset of an AIDS-defining illness⁴. HIV care and management have advanced significantly from the beginning of the epidemic, and today, people living with HIV (PLWH) who adhere to their antiretroviral therapy (ART) have a similar life expectancy to HIV-negative people⁵. This has contributed to a significant proportion of people living with HIV in many countries being 50 years of age or older. This includes almost half of the people living with HIV in the United States.
Many patients with HIV will live healthy lives into old age, but for some, ageing with HIV will present some specific challenges, including those of a physical, emotional, social, or functional nature. Examples of these changes include mental health issues, social isolation, loneliness, and stigma and discrimination, each potentially driven by different causes compared to younger populations. Similarly, physical needs including frailty may be present, as can issues relating to polypharmacy, comorbidities, and chronic inflammation. We are dedicated to supporting implementation research focused on closing gaps that are preventing people who are ageing with HIV from living healthy lives.
Although there was a 70% decline of the number of children who were diagnosed with HIV between 2000 and 2015, an unacceptably high number of children continue to become infected today.¹
In 2019, 150,000 children were newly diagnosed with HIV. Ending paediatric HIV remains an urgent global health priority. In 2015, UNAIDS and global partners outlined the Start Free, Stay Free, AIDS Free framework, with related targets, focused on eliminating new HIV infections. Start Free focuses on preventing children from acquiring HIV during pregnancy, birth and throughout the breastfeed period; Stay Free on preventing adolescent girls and young women from acquiring HIV as they grow up; and AIDS Free on providing HIV diagnosis, treatment, care and support to children and adolescents living with HIV.²
Realization of the Start Free, Stay Free and AIDS Free framework faces several barriers, including missed opportunities to test pregnant women for HIV and testing children at birth, longer HIV diagnoses for pregnant women, slower treatment initiation, lower retention in care for pregnant and breastfeeding women, viral load suppression challenges.³ Implementation science can help to address several of these barriers. We are committed to supporting implementation research focused on closing gaps that are preventing the end of paediatric AIDS.
Long-Acting Treatment Implementation
Highly effective medications for HIV treatment exists that has improved clinical and virologic outcomes for people living with HIV. Until recently, medications involved taking a pill or pills daily. With the development of long-acting HIV treatment, daily dosing is no longer the only option. As long-acting regimens are developed, shown efficacious and become available, effective implementation will be critical to ensuring optimal access and uptake for those who need it them most. Effective implementation will require a sound understanding of the key contextual factors that determine whether and how these regimens will be used. Making these products acceptable and accessible for users and making adoption into clinical care feasible can be challenging. We are dedicated to finding best strategies within settings to support efforts to implement long-acting HIV treatment and prevention to foster successful uptake and use.
Adherence and Retention in Care
In 2014, UNAIDS proposed the 95‐95‐95 targets by 2025 to fast-track the end of the AIDS epidemic by 2030, whereby at least 95% of all people living with HIV should be diagnosed, at least 95% of those diagnosed should be on antiretroviral therapy and at least 95% of those on antiretroviral therapy should be virologically suppressed.
Ample evidence exists that the UNAIDS targets are attainable; early initiation of antiretroviral therapy reduces HIV morbidity and mortality and reduces incidence rates of HIV. However, to have the maximum benefits of antiretroviral therapy, it is important that people living with HIV are diagnosed early, linked to care, adhere to treatment, retained in care, and achieve and sustain virologic suppression. We are dedicated to finding innovative approaches to reach people who do not know their status and who are not being retained in care. It is also essential to identify strategies that work in supporting adherence to treatment and improving healthcare services.
- UNAIDS. Children and HIV – 2016 Fact Sheet. Available at: https://www.unaids.org/sites/default/files/media_asset/FactSheet_Children_en.pdf Last accessed: June 2020.
NP-GBL-HVU-WCNT-210008 | January 2022
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