Richard Gray

This session focused on the large-scale implementation of HIV prevention and treatment service delivery across a range of countries and settings. The presentations reported on the effect of enhancing access to services and the prevention and treatment coverage achieved.

The session started with Susan Maria Kiene describing the PATH/Ekkubo cluster randomized trial in Uganda which evaluated enhanced linkage following home based HIV testing across 56 rural villages and resulted in large increases in linkage to care, ART initiation, and retention. Priscila Pinto then showed the effect of Brazil’s Family Health Strategy, a primary health care program, on AIDS incidence and mortality. Data from the linked longitudinal cohort of > 3 million people showed that the strategy achieved a large reduction in AIDS incidence and mortality. The coverage of PrEP achieved in PEPFAR supported countries since 2019 was then presented by Hanna Demeke. More than 1.3 million people across 30 countries have initiated PrEP with substantial scale-up of PrEP among key populations despite COVID-19 but over 70% of female sex workers and men who have sex with men have not initiated PrEP. Finally, Timothy Broady described HIV prevention coverage among Australian gay and bisexual men with regular partners, an area of less focus. He showed an extremely high coverage of effective prevention has been maintained, but with an increased use of biomedical prevention, ensuring HIV transmission to regular partners remains low.

Implementation and scale-up of effective interventions for HIV prevention and treatment is crucial for the global response and eliminating HIV/AIDS as a public health threat. This session highlighted the benefits of achieving scale-up and the incorporation of HIV services into primary health care but didn’t focus on the considerable challenges and costs associated with the scale-up process that need to be considered. There have been considerable achievements in the scale-up of HIV prevention and treatment despite the impact of COVID-19 but in many settings the scale-up is ongoing and needs to continue.