The contribution of PrEP to the toolkit is most accurately captured in New South Wales where they observed a 35% reduction in state-wide new HIV diagnoses in MSM following rapid scale-up of PrEP in the EPIC trial, two seroconversions amongst 3927 years of follow-up amongst trial participants. In all these settings testing and treatment were already at scale when PrEP was introduced. San Francisco, central London and New South Wales have seen the largest gains. Within and beyond Europe, PrEP is undoubtedly contributing to the decline in new diagnoses reported in gay and other MSM, but the public health benefit is difficult to assess precisely and the impressive decline seen in some city clinics is not universal. MRC Clinical Trials Unit, University College London, London, UK K元 PrEP: what's happening in Europe and the world in general Differences in epidemiology of HIV and health systems across Europe necessitate context-specific strategies to strengthen and control HIV prevention and care efforts. While the tools to prevent HIV – including diversified testing strategies, treatment as prevention, PrEP and harm reduction – have multiplied in recent years, their application across Europe is uneven and, in most settings, far lower than needed to impact incidence. While some countries within the region have been successful in meeting and surpassing the 90-90-90 targets, others are facing enormous challenges and are lagging behind. Within sub-regions and among key populations within countries there is considerable diversity in diagnosis, proportion on treatment and viral suppression rates. Among those on treatment in the European region, 85% are virally suppressed with variations across sub-regions in Europe (92%, 78% and 74% in Western, Central and Eastern). Among those diagnosed, 64% are estimated to be on treatment and this, too, differs across the region with 90%, 73% and 46% of those diagnosed on treatment in Western, Central and Eastern sub-regions, respectively.
Whilst overall 80% of people in the European region have been diagnosed with HIV, this varies greatly across sub-regions with 86%, 83% and 76% of people diagnosed in Western, Central and Eastern Europe respectively. HIV incidence is increasing in the European region as a whole, although there are large epidemiological differences between Western, Central and Eastern Europe. KL2 Strategies to reduce HIV incidence in EuropeĮuropean Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden It honours Jacqueline Van Tongeren and Joep Lange and their work, and is dedicated to their memory. This presentation will review progress in the AIDS response in the overall context of current global health. UNAIDS has targeted 30 million people to be on ART by 2020, when fiscal requirements are expected to be 26 billion US dollars annually current expenditure is about 7 billion US dollars less. There is controversy around how “the end of AIDS” is defined, about whether this ambitious goal is achievable and whether AIDS exceptionalism is still appropriate. Central to the global effort is the UNAIDS 90-90-90 initiative which requires 90% of persons with HIV to be diagnosed, 90% of those to receive ART and 90% of the treated to be virally suppressed. Sustainable Goal (SDG) 3 calls for an end to the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases by 2030, and the concomitant UNAIDS Fast-Track Strategy aims to reduce new HIV infections to no more than 500,000 annually by 2020 and 200,000 by 2030. KL1 HIV/AIDS, global health and the Sustainable Development GoalsĬDC Country Office, US Centers for Disease Control and Prevention, Nairobi, Kenya