Go Where the Virus Is: An HIV Micro-epidemic Control Approach to Stop HIV Transmission

Abstract

Essentially all HIV transmission is from people living with HIV who are not virally suppressed. An HIV micro-epidemic control approach that differentiates treatment support and prevention services for people living with HIV and their network members according to viral burden could optimize the impact of epidemic control efforts.

Liz Brenda Kandeyi, nurse (left), takes a client through the steps for clinical services at Kikuyu Sasa Center, Nairobi, Kenya. © 2017 Nancy Coste/FHI 360

FIGURE 1.

An HIV Micro-epidemic Control Model Aims to Prioritize and Focus Treatment and Prevention Efforts Where They Can Have the Greatest Impacts: Among a Shrinking Proportion of Individuals and Risk Networks With the Greatest Viral Burdens Abbreviations: AHI, acute HIV infection; ART, antiretroviral therapy; HIV+, HIV-positive; HIV-, HIV-negative; PLHIV, people living with HIV; PrEP, pre-exposure prophylaxis.

FIGURE 2.

The Natural History of HIV Disease Progression in the Absence of Antiretroviral Therapy, Variable Transmission Probabilities Associated With Viral Burden, and Capacities for Detection of HIV Infection Through Different Diagnostics Abbreviations: Ag, antigen; Ab, antibody; PCR, polymerase chain reaction.

FIGURE 3.

An Algorithm for Routine Screening for Acute HIV Infection in Populations Facing Elevated HIV Infection Risks Abbreviations: ART, antiretroviral therapy; DBS, dried blood spot; HTS, HIV testing services; PCR, polymerase chain reaction; PrEP, pre-exposure prophylaxis; VL, viral load.^a Individuals with nonreactive results on the first or “screening” test would be notified as likely uninfected but as falling within a window period for possible HIV infection pending the outcome of the DBS HIV PCR testing.

FIGURE 4.

An Illustrative Workflow for Acute HIV Infection Screening, Additionally Applying Recency Testing Data to Help Improve Focus Abbreviations: Ab+, antibody positive; Ab−, antibody negative; AHI, acute HIV infection; Ag+, antigen positive; Ag−, antigen negative; ART, antiretroviral therapy; HIV+, HIV-positive; PLHIV, people living with HIV.