FT Health: Act now to reinvigorate efforts on Aids

The guest curator of this week’s FT Health newsletter is Peter Piot, director of the London School of Hygiene and Tropical Medicine who focuses on the challenges for HIV/Aids campaigns. 

I was in Amsterdam this week at the 22nd International Aids Conference, a unique gathering of more than 17,000 people, bringing together a remarkable group of activists, people living with HIV, top scientists, political leaders and many more working on HIV around the world. Having attended many of these conferences, it was truly inspiring to see so many young, motivated advocates present this year. No other medical or health conference hosts such diverse constituencies.

The meeting could not have come at a more critical time. Despite unprecedented progress against Aids in many countries, the hard truth is that the end of the HIV pandemic is by no means in sight. We have heard promises of the “End of Aids” but, as a new joint report by the International Aids Society and Lancet Commission finds, this rhetoric has bred a dangerous complacency that may have actually weakened our global will to fight the epidemic.

Now is the critical moment to reinvigorate our efforts. According to a recent UNAids report, approximately 50 countries across the world experienced a rise in new HIV infections in 2017, about 40 per cent among key population groups. The epidemic is out of control in eastern Europe and central Asia, where new infections rose by almost 30 per cent in 2010-2017.

Despite life-saving HIV treatment, we are still seeing an increase in deaths in some parts of the world, such as in the Middle East and north Africa. With the largest-ever generation of young people in sub-Saharan Africa and the reality that tens of millions of people will need access to therapy in the coming years, now is not the time to be complacent.

Yet I remain optimistic. This week I witnessed passionate, informed rallying calls to reboot the HIV response and to make sure that Aids remains firmly on our agenda. Investing in health systems that put people at the centre will be the key to getting the Aids response back on track.

The book I am currently reading is Pale Rider: The Spanish Flu of 1918 and How It Changed the World by Laura Spinney.

Three questions

Peter interviewed Nduku Kilonzo, director of the National Aids Control Council (NACC) in Kenya and longstanding leader and advocate in the global response to HIV/Aids.

Where do you think we are with the global response to Aids?

We have made a lot of progress but we must go back to the basics. When I say that, I mean primary HIV prevention. We still have nearly 2m new infections every year. We will definitely not be able to meet global targets and goals with that level of new infections — so we must go back to the basics.

Kenya has one of the most dynamic HIV programmes. What is the key to this success?

It’s true that Kenya has made a lot of progress. I think our success is rooted in the existence of a strong co-ordination framework, partnerships by the National Aids Control Council with communities of persons living with HIV and other non-state actors, and the leadership of the government through the Ministry of Health. ‎We transcend traditional silos, for example, by collaborating with the education sector to connect with young people, who experience the highest number of new infections.

Kenya is hyper-decentralised. How do you manage this with local variations in the epidemic?

Recognising those differences, and the autonomy of county governments, the first thing we did was develop in-house capacity of young Kenyan biostatisticians to generate and examine granular data. These are the basis for engagement with the different counties. We work with them to develop targeted plans but also to produce progress reports on county-level responses, which are available for review and aggregation for national policymaking.

Peter Piot’s news picks

US FDA approves first drug for P. vivax treatment in over 50 years (Infectious Diseases Hub) 

Aids battle threatened by complacency, UN body says (FT)

The eye doctor who could not see the stars (BBC)

Ending Aids? These three places show the epidemic is far from over (Science)

Greece wildfires: Dozens dead in Attica region (BBC)

No recommended Brexit dosage yet for medicine research (FT)

Congo declares Ebola flare-up over after rapid response (Reuters)

Don’t let politics come between me and my patients (NYT)

The safety of CRISPR-Cas9 gene editing is being debated (The Economist)

Publications/reports

Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals. This important assessment shows we are not on track to end the HIV pandemic and we need to work together to reboot the response, ensuring we put people at the centre of our efforts. (International Aids Society/Lancet)

Miles to go — closing gaps, breaking barriers, righting injustices. The 2018 global report presents the latest data on the state of HIV/Aids and issues a strong wake-up call that, despite gains, numerous people are being left behind in the global Aids response. (UNAids)

Expert consensus statement on the science of HIV in the context of criminal law. (JIAS)

Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report We have learnt important lessons from the 2014 Ebola outbreak in west Africa but there is still a lot to learn about the virus itself. (Lancet Infectious Diseases)

Evaluation of the social impact bond trailblazers in health and social care Governments around the world are looking for new financing mechanisms for health and care. Policymakers should try to learn from different models but it seems social impact bonds might not be the silver bullet for better commissioning of health and care services. (Policy Innovation Research Unit, LSHTM)

Rapid urine-based screening for tuberculosis in HIV-positive patients admitted to hospital in Africa (STAMP): a pragmatic, multi-centre, parallel-group, double-blind, randomised controlled trial. TB kills more people than any other infectious disease so a new, effective diagnostic test is extremely important. (Lancet)

Association of retinal nerve fibre layer thinning with current and future cognitive decline: A study using optical coherence tomography Defeating dementia is one of the greatest global health challenges of our time. We must find ways of detecting it early. (JAMA Neurology)

Bringing population mobility into focus to achieve HIV prevention goals. We must do better to ensure that migrants and displaced populations can access HIV prevention and treatment services, as well as other broader social services. (JIAS)

Evaluation of a mosaic HIV-1 vaccine in a multi-centre, randomised, double-blind, placebo-controlled, phase 1/2a clinical trial (APPROACH) and in rhesus monkeys. A vaccine will be essential if we are to end the HIV pandemic. (Lancet)

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