Review

. 2018 Jul 28;392(10144):312-358.

doi: 10.1016/S0140-6736(18)31070-5. Epub 2018 Jul 20.

Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission

Linda-Gail Bekker¹, George Alleyne², Stefan Baral³, Javier Cepeda⁴, Demetre Daskalakis⁵, David Dowdy⁶, Mark Dybul⁷, Serge Eholie⁸, Kene Esom⁹, Geoff Garnett¹⁰, Anna Grimsrud¹¹, James Hakim¹², Diane Havlir¹³, Michael T Isbell¹¹, Leigh Johnson¹⁴, Adeeba Kamarulzaman¹⁵, Parastu Kasaie¹⁶, Michel Kazatchkine¹⁷, Nduku Kilonzo¹⁸, Michael Klag¹⁹, Marina Klein²⁰, Sharon R Lewin²¹, Chewe Luo²², Keletso Makofane²³, Natasha K Martin⁴, Kenneth Mayer²⁴, Gregorio Millett²⁵, Ntobeko Ntusi²⁶, Loyce Pace²⁷, Carey Pike²⁸, Peter Piot²⁹, Anton Pozniak³⁰, Thomas C Quinn³¹, Jurgen Rockstroh³², Jirair Ratevosian⁶, Owen Ryan¹¹, Serra Sippel³³, Bruno Spire³⁴, Agnes Soucat³⁵, Ann Starrs³⁶, Steffanie A Strathdee³⁷, Nicholas Thomson³⁸, Stefano Vella³⁹, Mauro Schechter⁴⁰, Peter Vickerman⁴¹, Brian Weir¹⁶, Chris Beyrer⁴²

Affiliations

¹ International AIDS Society, Geneva, Switzerland; Desmond Tutu HIV Centre, University of Cape Town, South Africa. Electronic address: Linda-gail.bekker@hiv-research.org.za.
² NCD Alliance, Office of the Director, Pan American Health Organization, Washington, DC, USA.
³ Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
⁴ Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, San Diego, CA, USA.
⁵ New York City Department of Health, New York, NY, USA.
⁶ Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
⁷ Centre for Global Health and Quality, Georgetown University School of Medicine, Washington, DC, USA.
⁸ Department of Dermatology and Infectious Diseases, Medical School, Felix Houphouet Boigny Universty Abidjan, Cote d'Ivoire.
⁹ HIV, Health and Development Group, United Nations Development Programme, New York, NY, USA.
¹⁰ HIV Delivery, Bill & Melinda Gates Foundation, Washington, DC, USA.
¹¹ International AIDS Society, Geneva, Switzerland.
¹² Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
¹³ Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California-San Francisco, San Fransisco, CA, USA.
¹⁴ School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
¹⁵ Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
¹⁶ Department of Health, Behaviour and Society, Johns Hopkins University, Baltimore, MD, USA.
¹⁷ UNAIDS and Global Health Center, Graduate Institute, Geneva, Switzerland.
¹⁸ National AIDS Control Council for Kenya, Nairobi, Kenya.
¹⁹ Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA.
²⁰ Division of Infectious Diseases, Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada.
²¹ The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia.
²² HIV/AIDS Section, United Nations Children's Fund, New York City, NY, USA.
²³ Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
²⁴ The Fenway Institute, Harvard Medical School, Boston, MA, USA.
²⁵ The Foundation for AIDS Research, New York City, NY, USA.
²⁶ Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
²⁷ Global Health Council, Washington, DC, USA.
²⁸ Desmond Tutu HIV Centre, University of Cape Town, South Africa.
²⁹ London School of Hygiene and Tropical Medicine, London, UK.
³⁰ HIV Services, Chelsea and Westminster NHS Foundation Trust Hospital, London, UK.
³¹ Centre for Global Health, Johns Hopkins University, Baltimore, MD, USA; International AIDS Society-National Institute for Drug Abuse, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, MD, USA.
³² HIV Clinic, Department of Medicine, University Hospital Bonn, Bonn, Germany.
³³ Center for Health and Gender Equity, Washington DC, USA.
³⁴ Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
³⁵ Health Systems, Governance and Financing, World Health Organisation, Geneva, Switzerland.
³⁶ Guttmacher Institute, New York, NY, USA.
³⁷ Global Health Sciences, Department of Medicine, University of California-San Diego, San Diego, CA, USA.
³⁸ Centre for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Nossal Institute for Global Health, University of Melbourne, VIC, Australia.
³⁹ Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
⁴⁰ Department of Preventative Medicine, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil.
⁴¹ School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK.
⁴² International AIDS Society, Geneva, Switzerland; Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.

PMID: 30032975
PMCID: PMC6323648
DOI: 10.1016/S0140-6736(18)31070-5

Review

Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission

Linda-Gail Bekker et al. Lancet. 2018.

. 2018 Jul 28;392(10144):312-358.

doi: 10.1016/S0140-6736(18)31070-5. Epub 2018 Jul 20.

Authors

Affiliations

¹ International AIDS Society, Geneva, Switzerland; Desmond Tutu HIV Centre, University of Cape Town, South Africa. Electronic address: Linda-gail.bekker@hiv-research.org.za.
² NCD Alliance, Office of the Director, Pan American Health Organization, Washington, DC, USA.
³ Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
⁴ Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, San Diego, CA, USA.
⁵ New York City Department of Health, New York, NY, USA.
⁶ Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
⁷ Centre for Global Health and Quality, Georgetown University School of Medicine, Washington, DC, USA.
⁸ Department of Dermatology and Infectious Diseases, Medical School, Felix Houphouet Boigny Universty Abidjan, Cote d'Ivoire.
⁹ HIV, Health and Development Group, United Nations Development Programme, New York, NY, USA.
¹⁰ HIV Delivery, Bill & Melinda Gates Foundation, Washington, DC, USA.
¹¹ International AIDS Society, Geneva, Switzerland.
¹² Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
¹³ Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California-San Francisco, San Fransisco, CA, USA.
¹⁴ School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
¹⁵ Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
¹⁶ Department of Health, Behaviour and Society, Johns Hopkins University, Baltimore, MD, USA.
¹⁷ UNAIDS and Global Health Center, Graduate Institute, Geneva, Switzerland.
¹⁸ National AIDS Control Council for Kenya, Nairobi, Kenya.
¹⁹ Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA.
²⁰ Division of Infectious Diseases, Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada.
²¹ The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia.
²² HIV/AIDS Section, United Nations Children's Fund, New York City, NY, USA.
²³ Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
²⁴ The Fenway Institute, Harvard Medical School, Boston, MA, USA.
²⁵ The Foundation for AIDS Research, New York City, NY, USA.
²⁶ Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
²⁷ Global Health Council, Washington, DC, USA.
²⁸ Desmond Tutu HIV Centre, University of Cape Town, South Africa.
²⁹ London School of Hygiene and Tropical Medicine, London, UK.
³⁰ HIV Services, Chelsea and Westminster NHS Foundation Trust Hospital, London, UK.
³¹ Centre for Global Health, Johns Hopkins University, Baltimore, MD, USA; International AIDS Society-National Institute for Drug Abuse, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, MD, USA.
³² HIV Clinic, Department of Medicine, University Hospital Bonn, Bonn, Germany.
³³ Center for Health and Gender Equity, Washington DC, USA.
³⁴ Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
³⁵ Health Systems, Governance and Financing, World Health Organisation, Geneva, Switzerland.
³⁶ Guttmacher Institute, New York, NY, USA.
³⁷ Global Health Sciences, Department of Medicine, University of California-San Diego, San Diego, CA, USA.
³⁸ Centre for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Nossal Institute for Global Health, University of Melbourne, VIC, Australia.
³⁹ Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
⁴⁰ Department of Preventative Medicine, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil.
⁴¹ School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK.
⁴² International AIDS Society, Geneva, Switzerland; Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.

PMID: 30032975
PMCID: PMC6323648
DOI: 10.1016/S0140-6736(18)31070-5

No abstract available

PubMed Disclaimer

Figures

**Figure 1**
Ten leading causes of death in 2015 (A) Low-income economies. (B) Low-middle-income economies. (C) Upper-middle-income economies. (D) High-income economies. Source: WHO.

**Figure 2**
Life expectancy in 2000 and 2016 Source: WHO.

**Figure 3**
Global burden of hepatitis B virus and hepatitis C virus (A) Prevalence of hepatitis B virus infection between 1957 and 2013. (B) Prevalence of anti-hepatitis C virus between 1990 and 2013. Adapted from Schweitzer et al (2015) and from Gower et al (2014), by permission of Elsevier.

**Figure 4**
Knowledge of HIV status, treatment coverage, and viral load suppression by region in 2016 Comparison of HIV testing and treatment cascades by region reveals different patterns of progress. Western and central Europe and North America are approaching global targets. Latin America and eastern and southern Africa show high levels of achievement across the cascade. Eastern Europe and central Asia, the Middle East and North Africa, and western and central Africa are clearly off track. Source: UNAIDS special analysis, 2017.

**Figure 5**
African American men who have sex with men have an increased lifetime acquisition probability of HIV infection in 2018 Credit: © NASTAD.

**Figure 6**
Activism on HIV in India Students recognise International AIDS Candlelight Memorial Day with painted faces at the Centre for Social Work, Panjab University, Chandigarh, India. Credit: © 2016 Gaurav Gaur, Photoshare.

**Figure 7**
Sexual and emotional health in adolescents in India A young girl attends a candlelit march for sexual and emotional health for young teens in Udaipur, India. Credit: © 2016 Arvind Jodha/UNFPA, Photoshare.

**Figure 8**
HIV testing, family planning education and referrals, and deworming kits in Uganda A dance troupe with Public Health Ambassadors Uganda perform in the Kasana Market in Luwero to call attention to a pop-up health clinic providing HIV testing, family planning education and referrals, and deworming kits. Credit: © 2016 David Alexander, Photoshare.

**Figure 9**
HIV testing services in Kenya A counsellor provides HIV testing services to livestock herders during community outreach services in the Eremit area of Kajiado County, Kenya. Credit: © 2012 George N Obanyi/FHI 360, Photoshare.

**Figure 10**
Prevention of mother-to-child transmission of HIV in Nigeria Mothers and children in Alausa Area of Lagos, Nigeria, during a state-sponsored educational programme on prevention of mother-to-child transmission of HIV. Credit: © 2014 Kunle Ajayi, Photoshare.

**Figure 11**
Monitoring babies for signs of congenital Zika syndrome in Honduras At Tela Hospital in El Progreso City, Honduras, Ileana Mayes Flores, the only geneticist in the public sector of Honduras, examines Aylin Meja, a baby aged 3 months whose mother, Sandra Meja aged 19 years, was infected with the Zika virus during pregnancy. The medical staff is closely monitoring her baby for signs of congenital Zika syndrome. Credit: © 2017 Brendan Bannon/USAID, Photoshare.

**Figure 12**
Patients undergo drug detoxification while handcuffed to their beds at a programme for heroin addiction in Ekaterinburg, Russia Credit: Brendan Hoffman.

**Figure 13**
A multicountry modelling exercise to study the effect of HIV integration in various settings NCDs=non-communicable diseases. MSM=men who have sex with men. FSW=female sex workers. ART=antiretroviral therapy.

**Figure 14**
South African health statistics and the potential effects of multidisease screening (A) HIV estimates are obtained from the Thembisa model estimates for 2016, whereas diabetes and hypertension estimates are from the 2012 South African National Health and Nutrition Examination Survey. Controlled on treatment is defined in the case of HIV as having a viral load less than 400 copies per mL, and in the case of diabetes as a HbA_1c concentration less than 7%. Estimates of treatment coverage and control rates among hypertension cases are obtained from a national survey in 2010. (B) The expected fraction of screened individuals testing positive, the expected fraction of newly diagnosed individuals, and the expected fraction of individuals linking to treatment services in the context of a multidisease screening programme implemented between 2018 and 2028.

**Figure 15**
Differented care in South Africa—The Tutu Tester mobile screening programme for HIV, tuberculosis, diabetes, hyptertension, and body-mass index Credit: Desmond Tutu HIV Research Foundation/Alexis Dominguez.

**Figure 16**
Projected effects of HIV and NCD integration scenarios in Kenya (A–B) The projected effect of the intervention on the number of new HIV infections and AIDS deaths in Kenya in the next decade (2018–28). (A) Effects of the care cascade in intervention communities in 2018, and similar patterns of improvement in cascades are expected for each new set of intervention communities. (B) Improvements in care cascades in 2018 averaged for the whole country. National care cascades are expected to continue to improve through the end of programme in 2028. (C–D) The care cascades for HIV, hypertension, and diabetes in adults before and after first year (2018) of implementation in intervention communities and in Kenya, respectively. Intervention communities constitute representative 10% of the adult population (aged ≥15 years), with assumption of 90% screening uptake and treatment uptake after diagnosis of 81% for HIV, 23% for hypertension, and 45% for diabetes. NCD=non-communicable disease. ART=antiretroviral therapy.

**Figure 17**
Projected effects of HIV and reproductive health services integration scenarios in Nigeria (A) Total fertility rate. (B) Number of unintended pregnancies averted. (C) Number of infants infected with HIV. (D) Cumulative number of new HIV infections in Nigeria. Scenarios include expansion of family planning services by increasing the prevalence of contraceptive use from 16% at baseline to 31% in 2023, and expansion of PMTCT by increasing the coverage to reach 90% of HIV-positive pregnant women in Nigeria by year 2023, compared against baseline levels in Nigeria. PMTCT=prevention of mother-to-child transmission.

**Figure 18**
Projected effects of HIV and sexually transmitted infection services integration scenarios for MSM and FSW in India The number of new HIV infections in (A) MSM and (B) FSW. Intervention scenarios include expansion of ART coverage in MSM (from 43% to 73%) and FSW (from 29% to 81%) with no PrEP, at a low PrEP coverage of 10%, and at a high PrEP coverage of 30%. Each scenario is modelled as a gradual increase in coverage of ART and PrEP in MSM and FSW from 2018 to 2023, continued at a fixed coverage afterward (2024 to 2028). MSM=men who have sex with men. FSW=female sex workers. PrEP=pre-exposure prophylaxis. STI=sexually transmitted infections.

**Figure 19**
Model projections of the effect of integrated harm reduction and HIV services in two Russian cities Model projections of (A) median HIV prevalence in PWID in Omsk, Russia, (B) median HIV prevalence in PWID in Ekaterinburg, Russia, (C) proportion HIV infections averted in PWID in 2018–28, and (D) proportion of fatal overdoses averted in PWID in 2018–28 with various levels of intervention scale-up. Scenarios include no harm reduction or ART (base case), expansion of NSPs to 50% coverage in PWID (NSP 50%), expansion of MAT to 25% or 50% of PWID (MAT 25%; MAT 50%), combination MAT and NSP to 50% of PWID (MAT+NSP 50%), or combination MAT and NSP to 50% of PWID integrated with ART recruited at three times the base-case recruitment rate of HIV-infected PWID on harm reduction per year from 2018. Observed HIV prevalence data in PWID shown as black circles and 95% CI; dashed lines are 2·5–97% uncertainty bounds. Box plots indicate the median (middle line) projections, 25–75% percentile range (boxes), and 2·5–97·5% percentile range (whiskers), and median estimates reported above box plots. PWID=people who inject drugs. ART=antiretroviral therapy. MAT=medication-assisted therapy. NSP=needle and syringe programme.

**Figure 20**
Community-led prevention providing combination prevention including pre-exposure prophylaxis to their peers in Thailand Credit: © Richard Nyberg, USAID.

See this image and copyright information in PMC

Comment in

The HIV response and global health.
Guise A. Guise A. Lancet. 2019 Apr 27;393(10182):1695-1696. doi: 10.1016/S0140-6736(19)30355-1. Lancet. 2019. PMID: 31034373 No abstract available.
The HIV response and global health.
Glass RI, El-Sadr W, Goosby E, Kupfer LE. Glass RI, et al. Lancet. 2019 Apr 27;393(10182):1696. doi: 10.1016/S0140-6736(19)30353-8. Lancet. 2019. PMID: 31034374 No abstract available.
A COVID-19 conference at AIDS 2020: Virtual.
Pozniak A, Bekker LG, Kamarulzaman A, Gandhi M, Horton R, Das P, Beyrer C. Pozniak A, et al. Lancet. 2020 May 23;395(10237):1598-1599. doi: 10.1016/S0140-6736(20)31026-6. Epub 2020 Apr 30. Lancet. 2020. PMID: 32359401 Free PMC article. No abstract available.

References

1. AIDSInfo Joint United Nations Programme on HIV/AIDS. http://aidsinfo.unaids.org - PubMed
1. Piot P, Quinn TC. Response to the AIDS pandemic—a global health model. N Engl J Med. 2013;368:2210–2218. - PMC - PubMed
1. GBD 2016 Causes of Death Collaborators Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1151–1210. - PMC - PubMed
1. Global Burden of Disease Health Financing Collaborator Network Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet. 2017;389:2005–2030. - PMC - PubMed
1. UN . Joint United Nations Programme on HIV/AIDS; Geneva: 2017. Ending AIDS. Progress towards the 90–90–90 targets.

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Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission

Affiliations

Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission

Authors

Affiliations

Figures

Comment in

References

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Grants and funding

LinkOut - more resources

Full Text Sources

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Medical