Toward an endgame: finding and engaging people unaware of their HIV-1 infection in treatment and prevention

Abstract

Epidemic modeling suggests that a major scale-up in HIV treatment could have a dramatic impact on HIV incidence. This has led both researchers and policymakers to set a goal of an "AIDS-Free Generation." One of the greatest obstacles to achieving this objective is the number of people with undiagnosed HIV infection. Despite recent innovations, new research strategies are needed to identify, engage, and successfully treat people who are unaware of their infection.

FIG. 1.

Nonlinear nature of the HIV treatment continuum. Some persons will fail to test, test but decline linkage to care, or link but decline treatment until symptoms occur. Others will achieve some or all of these milestones but later drop out of care and treatment. Entry is therefore constantly occurring not only through the “front door” but also through at least two “side” doors.

FIG. 2.

Elimination threshold as a function of the annual treatment uptake and dropout rate for various values of the basic reproduction number R₀. The two curves describe the threshold for R₀=2.0 and for R₀=3.0. For parameter combinations above the lines, elimination is possible; for combinations below the curve it is not possible.