Haitian Ministry of Public Health and Population Launches First-Ever Population-based HIV Impact Assessment

Over the past few decades, Haiti has suffered one of the worst HIV epidemics in the Caribbean region, with an estimated 2% of adults, ages 15-49, currently living with HIV. Prone to facing natural disasters, such as earthquakes and hurricanes, infrastructural barriers in accessing health services during these periods also have a significant impact on HIV prevention and treatment access in the country. Despite these challenges, Haiti has made significant strides in reducing new HIV infections and AIDS-related deaths by 25% over the last decade.

Taking a step forward to further this progress, the Government of Haiti has committed to conducting a national-level survey to collect the data it needs to help address this public health crisis.

With the ongoing collaboration between the U.S. Centers for Disease Control (CDC), ICAP at Columbia University, and ministries of health in countries across the world, and funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Haitian Ministry of Public Health and Population has launched the first-ever Haiti Population-based HIV Impact Assessment (HAPHIA).

Haiti will be the fourteenth country where a Population-based HIV Impact Assessment (PHIA) will take place. It is the first PHIA to take place outside of Africa and in the Caribbean, the world’s second-most HIV-affected region. HAPHIA will benefit from the lessons learned by previous PHIAs as the project – which has been a game-changer for the global HIV response – completes its first round of surveys started in 2015 and prepares to begin a new series of surveys to be completed in 2020.

Officiating the launch on June 11, 2019, Dr. Greta Roy Clément, minister of Public Health and Population, highlighted HAPHIA’s role in capturing 15 years of major progress for HIV treatment and care in Haiti. “The HAPHIA survey,” she noted in French, “will measure national-level, statistical data on HIV in order to better reach target populations in need of services.”

This national, household-based survey will be the first of its kind to measure the reach and impact of the country’s HIV prevention, care, and treatment services. This information is critical to help Haiti chart a course to reach the UNAIDS’ 90-90-90 targets and, ultimately, bring the HIV epidemic under control.

The HAPHIA launch was attended by the U.S. Global AIDS Coordinator, Ambassador-at-Large Deborah L. Birx, who emphasized PEPFAR’s commitment to ending the HIV epidemic and making a difference in people’s lives around the world.

The launch also included remarks from ICAP’s Senior Technical Director, Jessica Justman; Principal Investigator of HAPHIA – MSPP, Pavel Desrosiers; CDC Haiti Director, Samuel Martinez; U.S. Ambassador to Haiti, Michele J. Sison.

The survey will reach nearly 12,500 randomly selected households across all ten divisions of the country. Data collection for HAPHIA began July 1st.

To get the latest updates, visit: https://phia.icap.columbia.edu/countries/haiti/

 

 

Eswatini Measures Strides Towards HIV Epidemic through SHIMS2, Demonstrating Epidemic Control is Possible

Leadership from the Ministry of Health – Eswatini, ICAP at Columbia University, NERCHA and SHIMS2 investigators with officiating dignitaries of the SHIMS2 Final Report Commissioning

The Government of the Kingdom of Eswatini (GKoE) remains the country with the highest HIV prevalence in the world, with nearly 1 in 3 adults (15 years and older) living with HIV. Over the last decade, the expansion of HIV testing and increase in the number of individuals living with HIV on antiretroviral treatment has demonstrated substantial progress in the nation’s HIV response.

Providing the latest update on the status of the epidemic, the final report and results of the second Swaziland (Eswatini) HIV Incidence Measurement Survey (SHIMS2) were commissioned by the government and disseminated on May 9, 2019, at a meeting in Ezulwini, Eswatini. The meeting was officiated by high-level officials from the GKOE and the United States Government agencies.

The meeting also marked the launch of a new survey, SHIMS3 2020, scheduled for completion by World AIDS Day 2020.

The United States Ambassador to Eswatini, Lisa Peterson (R), the Minister of Health Eswatini, Lizzy Nkosi (second to R), and Director of Central Statistical Office Eswatini, Amos Zwane (M) commission the start of the new SHIMS survey

SHIMS2 was a population-based HIV impact assessment (PHIA) survey led by the GKoE’s Ministry of Health, in close collaboration with the Central Statistics Office, ICAP at Columbia University, and the U.S. Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR). In 2011, Eswatini’s first nationally representative HIV incidence survey, SHIMS1, was also carried out through this partnership.

Findings from SHIMS1 and SHIMS2 show that between 2011 to 2016, HIV incidence decreased by 44% and the prevalence of viral load suppression more than doubled. These advancements demonstrate that national HIV programs and treatment as prevention can reduce new HIV infections even in countries highly impacted by HIV, such as Eswatini. Speaking at the meeting, Ms. Lisa Peterson, the United States Ambassador to Eswatini, lauded the successful implementation of SHIMS2, including progress towards 90-90-90 targets and dedicated work of the GKoE’s treatment programs. “Through the findings of SHIMS1 and SHIMS2, Eswatini has provided evidence that epidemic control of HIV is possible,” she noted.

SHIMS2 also found that, in 2016, 27.0% of adults (15 years and older) in Eswatini were living with HIV and 87% of them knew their status. Of those who knew their status, most (88.8%) were on antiretroviral therapy (ART), and among those on ART, most were virally suppressed (91.4%). These results demonstrate that Eswatini has nearly completed the 90-90-90 targets, with the potential to reach 95-95-95 by 2020.

The GKoE’s Minister of Health, the Honorable Senator Lizzie Nkosi, emphasized that “the SHIMS2 final report can be used to support the adoption of HIV mitigation strategies that may allow for the epidemic control of HIV in Eswatini.”

Group discussion at the SHIMS2 tehnical meeting on the implications and policy direction of the final report results

After the commissioning of the SHIMS2 final report and launch of SHIMS3 2020, a technical meeting was held to discuss and translate the report findings to address gaps and inform health policies. The technical meeting was well-attended by clinicians, programmers, and civil society representatives, including people living with HIV, from across the country. Through group discussions, participants developed recommendations on how to apply SHIMS2 findings to existing national policies and programs on HIV prevention, testing, care and treatment.

ICAP’s David Hoos, MD, the PHIA project director, applauded the success of the HIV response in Eswatini and the government’s commitment to end the epidemic. “SHIMS2 showed the impressive progress achieved in the Kingdom with a significant decrease in HIV incidence, which occurred concurrently with a dramatic rise in HIV treatment coverage with impressive increase in HIV viral load suppression. This is the largest population-level validation of ‘treatment as prevention’ and the epidemiologic potential of the 90-90-90 targets,” he said.

For additional information and access to the final report, visit: phia.icap.columbia.edu/countries/Eswatini


SHIMS2 was a population-based HIV impact assessment (PHIA) survey led by the GKoE’s Ministry of Health, in close collaboration with the Central Statistics Office, ICAP at Columbia University, and the U.S. Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR). SHIMS2 provides an unprecedented understanding of the reach and impact of Eswatini’s HIV programs using nationally-representative, household-based surveys. This partnership also conducted the first SHIMS in 2011 to measure HIV incidence among adults 18-49 years. 

Final Results from Tanzania HIV Impact Survey Shed Light on Priorities for Strengthening the Country’s Efforts to Control HIV

Tanzania HIV Impact Survey Launch on April 13, 2019 in Dodoma, Tanzania

Tanzania, which has been one of the countries at the epicenter of the HIV epidemic in sub-Saharan Africa, now has a critical set of data about its progress in addressing HIV among its people – and equally critical insight into the work that still lies ahead.

On April 13, 2019, officials gathered in the Tanzanian capital, Dodoma, to announce the final results of the Tanzania HIV Impact Survey (THIS) 2016-17. The survey, which is part of the multi-country Population-based HIV Impact Assessment (PHIA), was conducted by ICAP at Columbia University in partnership with the Government of Tanzania through the Tanzania Commission for AIDS (TACAIDS) and Zanzibar AIDS Commission (ZAC), funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and technical assistance from the U.S. Centers for Disease Control (CDC). THIS provides an important new reference point in Tanzania’s march toward epidemic control within its borders and the global response to HIV at large.

In Tanzania, THIS was conducted between October 2016 – August 2017. It surveyed over 14,000 households and interviewed more than 33,000 adults (15 and older) and 10,000 children (14 and younger). The results provide extensive data on the number of people living with HIV in Tanzania (prevalence), number of new HIV infections occurring each year (incidence) and use of health services by people living with HIV.

At the event, the Minister of State in the Prime Minister’s Office responsible for Parliament, Policy Coordination, Labour, Employment, Youth and the Disabled, Jenista Mhagama, stressed the importance of using the THIS report to inform future HIV program implementation. “The main objectives from the results of THIS 2016-2016, apart from other interventions, is to prevent new HIV infections – for those who are HIV-negative to remain negative – and those found to be HIV positive to be enrolled into care and start ART immediately,” Minister Mhagama said.

Key findings from the report reveal that 5.0% of adults (15-64 years) in Tanzania are currently living with HIV. A large percentage of these adults – nearly 40% – are unaware of their positive status, well-below the UNAIDS target of 90% of all people living with HIV knowing their status by 2020. Conversely, there has been progress in adults living with HIV who are aware of their status, with 93.6% receiving anti-retroviral therapy (ART) and 87.0% of those on ART having viral load suppression.

Minister Mhagama also urged those working on HIV programming to encourage people to volunteer for HIV testing, provide counselling for those found to be living with HIV, and address HIV-related stigma and discrimination.

At the event, the Tanzania Commission for AIDS’ (TACAIDS) Executive Director, Dr. Leonard Maboko, encouraged policy makers, planners and stakeholders to use the report findings to make informed HIV policy decisions.

The findings furnish the government, key health stakeholders and the general public with official statistics for use in planning, policy making, monitoring and evaluating programs on HIV,” stated Dr. Maboko.

After the report’s release, the National Council of People living with HIV and AIDS (NACOPHA) announced that the results will be used to design awareness campaigns on prevention, medication and stigma for people living with HIV in Tanzania.

For additional information and access to the final report, visit: phia.icap.columbia.edu/countries/Tanzania


THIS was led by the Government of Tanzania through the Tanzania Commission for AIDS (TACAIDS) and Zanzibar AIDS Commission (ZAC), and the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), the Ministry of Health Zanzibar (MoH), National Bureau of Statistics (NBS) and the Office of Chief Government Statistician (OCGS). THIS was conducted with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and technical assistance through the U.S. Centers for Disease Control and Prevention (CDC) and ICAP at Columbia University.

ICAP Research Contributes to Detailed Maps of the HIV Epidemic

A new study co-authored by Jessica Justman, MD, Senior Technical Director at ICAP at Columbia University and Associate Professor of Medicine in Epidemiology at Columbia’s Mailman School of Public Health, captures the evolution and variation of the HIV epidemic over space and time in sub-Saharan Africa by using detailed provincial- and district-level maps of HIV prevalence in each country, down to the level of a small city.

The study, published in Nature, was conducted at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and is the first to map a comprehensive and comparable set of subnational HIV prevalence estimates. The study focuses on adults ages 15-49 years in 47 sub-Saharan African countries over a period of almost two decades. It includes data from ten countries involved in the global Population-based HIV Impact Assessment (PHIA) Project, funded by the US President’s Emergency Fund for AIDS Relief (PEPFAR) and implemented by ICAP in partnership with the U.S. Centers for Disease Control and Prevention (CDC).

“This research provides an unprecedented level of detail, down to 5×5 km cells, about the local scope of the HIV epidemic in sub-Saharan Africa between 2000 and 2017,” noted Dr. Justman, “As we have seen with PHIA survey results, the findings in this paper demonstrate just how varied the epidemic is within and across countries.”

HIV remains a leading cause of illness and death in sub-Saharan Africa. Despite the rapid scale-up of antiretroviral therapy (ART), according to UNAIDS, 34% of people in east and southern Africa and 60% in west and central Africa living with HIV are currently not receiving any treatment.

The newly published precise geographic maps of HIV prevalence will be an important tool to more efficiently target HIV resources and interventions. They reveal that most countries had or have more than a two-fold difference in prevalence between provinces and districts and in one quarter of the countries, the largest difference was over five-fold. The maps also demonstrate how existing national HIV prevalence maps obscure hotspots visible only with the finer 5×5 km-resolution maps used in this study.

The results show high variation in HIV prevalence and changes in prevalence over time within countries, with many areas experiencing increases in the same period where others experience declines. It found that one-third of people living with HIV live in a small number of densely populated areas while another one-third live in relatively sparsely populated areas. These findings highlight the changing HIV landscape and underscore the need for current and local data to understand the nuances of the epidemic in sub-Saharan Africa.

This study is another example of how the PHIA Project is providing nationally-representative, population-level HIV data to understand the extent of the HIV epidemic in sub-Saharan Africa. It also underscores the need to continue conducting HIV-focused population-based surveys to guide targeted treatment and prevention efforts in high-concentration areas.

“There’s an increasing appreciation that this epidemic is even less homogenous than people have imagined,” says Wafaa El-Sadr, MD, MPH, MPA, Director of ICAP, during an interview with NPR, “This kind of data helps to prompt other research questions: Can we do different kinds of interventions in these places?”

The results of this analysis provide a new tool for policymakers, program implementers and researchers to assess local needs and make more informed policy, programming and funding decisions to achieve global HIV prevention, diagnosis, and treatment targets.


This study was supported by The Bill & Melinda Gates Foundation and led by the Local Burden of Disease project at IHME, University of Washington. It is available at IHME’s website at www.healthdata.org. Data visualizations are available at https://vizhub.healthdata.org/lbd/hiv.

Columbia University President Visits PHIA Programs in Kenya and Rwanda

Columbia University President Lee C. Bollinger got a firsthand look at the impact that ICAP has been making on the HIV epidemic when he recently traveled to Kenya and Rwanda, where ICAP’s longstanding partnerships and support have helped these countries achieve significant progress.

Accompanied by his wife, Jean Magnano Bollinger, a visual artist, Professor Safwan Masri, executive vice president for Global Centers and Global Development, and Wafaa El-Sadr, ICAP global director, Bollinger met with health officials and ICAP staff to get a full picture of ICAP’s long history of engagement in these countries and its current portfolio of work.

A key focus of Bollinger’s visit was to witness the ambitious surveys currently being conducted by ICAP in partnership with the Ministries of Health and the U.S. Centers for Disease Control and Prevention (CDC). The Population-based HIV Impact Assessment (PHIA) Project involves large-scale population surveys that aim to provide a report card to the countries in terms of where they stand in responding to the epidemic, and to help them in charting a blueprint for future action. To date, such surveys have been conducted in 13 African countries, involving close to half a million participants. In both Kenya and Rwanda, these surveys were ongoing at the time of the visits.

During a two-day visit to the Kenyan capital, Nairobi, Bollinger received a full briefing on the Kenya survey—known as KENPHIA—which was in its final days of data collection. The briefing included a look at the KENPHIA “Situation Room” where monitors track the position and progress of the survey teams in real time all over the country.

In Rwanda, where the RPHIA data collection was still underway, Bollinger had the opportunity to accompany health survey teams on visits to the selected households in a rural area to witness the implementation of the survey firsthand.

“One of the highest aspirations of Columbia University is to put knowledge in the service of humanity—enabling people around the world to live longer and better lives,” said Bollinger. “By harnessing solid scientific evidence to improve health, it is clear that the PHIA project is bringing a new level of precision to the HIV response.”

In Kenya and Rwanda, in addition to the PHIA briefings, Bollinger also received an in-depth presentation on the variety of programs that ICAP supports. In Kenya, Bollinger met with Dr. Kigen Bartilol, director of Kenya’s National AIDS and STI Control Program (NASCOP), and other governmental leaders. In Rwanda, he engaged with the Honorable Dr. Diane Gashumba, Rwandan Minister of Health, and a contingent of ministry leadership, university deans and professors, and other dignitaries. He also had the opportunity to meet with CDC country directors in both countries.

Through these meetings, Bollinger had the opportunity to engage in discussions regarding broad health and development issues in the two countries, and to take note of their most compelling goals and aspirations for the future of their peoples.

While in the Rwandan capital of Kigali, the Bollinger delegation also paid their respects at the Kigali Genocide Memorial, which honors the memory of the more than one million Rwandans killed in 1994 and houses the remains of more than 250,000 victims.

“We are shocked by what we have seen,” said Bollinger after visiting the Memorial to the Rwandan national tragedy. “Yet, at the same time, we are encouraged by the great strides that Rwanda has made and are hopeful that this beautiful country shall never again endure such a tragedy.”

Under President Bollinger’s leadership since 2002, Columbia University stands among the world’s top research universities, distinguished by its academic excellence and an innovative and sustainable approach to global engagement. Exemplifying these unique values, ICAP has demonstrated a deep commitment to advancing evidence to action through its global partnerships and its broad portfolio of work around the world.

“We are honored to have had the opportunity to host President Bollinger and his delegation,” said El-Sadr. “We thank him for placing his confidence in us as we work together to make his vision of a truly global university a reality.”

Read this article on ICAP at Columbia University’s website here.

ICAP Funded $50M to Conduct HIV Population Surveys to Inform Efforts to Achieve Epidemic Control

ICAP at Columbia University has been awarded a $50 million grant from the U.S. Centers for Disease Control and Prevention (CDC) to conduct an extensive population survey effort in an array of countries and communities hardest hit by the global HIV epidemic.

The HIV Population Survey project will measure the reach and impact of HIV programs in countries designated as priorities by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), with the goal of gathering the critical data those countries need to guide their HIV programs and investments.

ICAP will implement the PEPFAR-funded project in partnership with CDC under the leadership of health ministries and a stellar group of strategic partners.

“This major new award builds on the notable achievements of the Population-based HIV Assessment (PHIA) project, which ICAP has been implementing in 14 countries for the past five years,” said Wafaa El-Sadr, MD, MPH, MPA, ICAP’s global director and principal investigator of the project. “The PHIA series of household surveys, which were also funded by PEPFAR and conducted in partnership with CDC and ministries of health, constitute the first multi-country population-level measurements of progress toward global epidemic control targets. With the new initiative, ICAP aims to continue and expand the effort to present an even more detailed picture of the epidemic at this critical moment.”

The new HIV survey project, which will begin this year and is expected to last six years, will have two areas of focus. Firstly, the project will support conducting general population surveys in a number of PEPFAR-priority countries mostly located in sub-Saharan Africa. Upcoming surveys are planned in Eswatini, Lesotho, Malawi, Mozambique, Uganda, and Zimbabwe. These surveys will rapidly collect high-quality, actionable data—including incidence, prevalence, and viral load suppression—through household surveys of the general population.

The second area of focus will involve surveys among key and priority populations. These populations—which include men who have sex with men, people who inject drugs, female sex workers, prisoners, and adolescent girls and young women—have been shown to bear a disproportionate burden of HIV. The information gathered through the surveys conducted among these groups will inform the response to their unique prevention and treatment needs.

In addition to data collection among general, key, and priority populations, the survey project will strengthen health ministry capacity to use data to inform national responses designed to reach global HIV targets.

“These surveys are important tools that policymakers, funders, and program managers need to assess both the progress they are making and the gaps that still remain, so they can make informed decisions about where to direct resources and how to shape programs,” said David Hoos, MD, MPH, who serves as project director for this initiative.

This project includes the following collaborating organizations: African Population and Health Research Center; African Society for Laboratory Medicine; Clinical Pharmacology Laboratory at the University of Cape Town; FHI 360; Frontier Science & Technology Research Foundation, Inc.; Institute for Global Health Sciences at the University of California, San Francisco; International Treatment Preparedness Coalition; Makerere University; Partnership for Supply Chain Management; PPD; and Westat.

Read this article on ICAP at Columbia University’s website here.

Final Results from Zambia National HIV Survey Demonstrate Notable Progress Toward Epidemic Control

On February 28, 2019, representatives from the Government of Zambia, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Centers for Disease Control and Prevention (CDC), and ICAP at Columbia University gathered in Lusaka to announce the final results of the Zambia Population-based HIV Impact Assessment (ZAMPHIA) survey. The extensive data provided in the ZAMPHIA final report show that Zambia has made notable progress toward controlling the nation’s HIV epidemic.

ZAMPHIA, a household-based, national survey was conducted between March and August 2016, and included more than 27,000 children and adults from nearly 11,000 randomly selected households across Zambia. Funded by the U.S. government through PEPFAR, it is the first national survey in Zambia to provide comprehensive information on key HIV/AIDS indicators at the national and regional level, and to measure progress toward the globally recognized UNAIDS 90-90-90 targets for the year 2020.

Final ZAMPHIA data show that in 2016, Zambia was close to achieving the UNAIDS 2020 targets, with 71 percent of people living with HIV in Zambia aware of their HIV diagnosis, 87 percent of all people diagnosed with HIV receiving antiretroviral therapy (ART), and 89 percent of people receiving ART virally suppressed. As noted in other countries, however, the data reveal that women in Zambia are disproportionately impacted by the HIV epidemic. HIV incidence (new HIV infections) was three times higher among women than men (ages 15–59), and HIV prevalence (current HIV infection) was four times higher among young women than men (ages 20–24).

“With my ministry taking the lead, there is a need for more intensive primary prevention among HIV-negative women, as well as targeting of secondary prevention, including safer sexual behaviors, HIV diagnosis, and treatment among HIV-positive individuals,” said Ministry of Health Permanent Secretary Kennedy Malama, MD, MPH. “The disparity in HIV prevalence between males and females, particularly in [young women], suggests more effort is needed to focus on early testing and ART initiation for adolescent girls and young women, as well as the need for preventative services.”

While the ZAMPHIA final report provides the most extensive data available on the HIV epidemic in Zambia to date, it builds on previously released, preliminary ZAMPHIA data that have already begun to shape the HIV response.

“The findings from ZAMPHIA provide a basis to target HIV interventions smartly,” said CDC Country Director Simon Agolory, MD. “Both the Ministry of Health and the U.S. government have used these data extensively to focus Government of Zambia and PEPFAR investments in HIV prevention and treatment.”

“We are privileged that Zambia was one of the first countries in Africa to implement the PHIA surveys,” said Prisca Kasonde, MD, MMed, MPH, ICAP’s country director in Zambia. “We know that the data from the first ZAMPHIA report have helped the government of Zambia and the different funding agencies and implementing partners to understand the impact that HIV programming has had on the HIV response in the country, as well as the gaps that still exist as Zambia strives to reach epidemic control.”

Recognizing the importance of publicly accessible data, full data sets from the ZAMPHIA survey are also now available on the PHIA website, along with data visualization tools that allow health researchers, policymakers, and program planners to explore the full range of survey results and to build tailored charts, graphs, and maps.

 

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A global health leader since 2003, ICAP was founded at Columbia University with one overarching goal: to improve the health of families and communities. Together with its partners—ministries of health, large multilaterals, health care providers, and patients—ICAP strives for a world where health is available to all. To date, ICAP has addressed major public health challenges and the needs of local health systems through 6,000 sites across 30 countries. For more information about ICAP, visit: icap.columbia.edu

 

 

LePHIA Data Link Climate Shock to HIV Infection Rates

There is a direct link between climate change and public health in Lesotho, according to findings from the Lesotho Population-Based HIV Impact Assessment (LePHIA). Data show that women and adolescent girls exposed to severe drought conditions in rural Lesotho were more likely to engage in high-risk behaviors, including sex work, and were more likely to drop out of school.

“This is the first paper to link climate shock to an HIV epidemic since antiretroviral drugs became more widely available in sub-Saharan Africa,” said Dr. Jessica Justman, senior technical director of ICAP at Columbia University and principal investigator of the PHIA Project. “We should view this as another kind of warning that climate change will affect us in unexpected and unwelcome ways.”

Read full news coverage on the  Africa Times  and Thomson Reuters Foundation websites.

View the findings published in PLOS Medicine.

Press Release: Final Results of National Survey Show Lesotho’s Remarkable Progress toward HIV Epidemic Control

PRESS RELEASE

January 16, 2019, Maseru – Today, the Government of Lesotho, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Centers for Disease Control and Prevention (CDC), and ICAP at Columbia University (ICAP) announced the final results of the Lesotho Population-based HIV Impact Assessment (LePHIA) survey. These extensive new data builds off of preliminary data announced in November 2017, which showed the remarkable strides Lesotho is making toward controlling its HIV epidemic.

The results announced today include extensive data on prevalence, incidence and uptake of HIV services for adults, adolescents and children as well as updates to previously released figures. The updated figures are based on new laboratory data showing the number of people already tested and aware of their HIV status was higher than initially reported in 2017 (81% today vs 77% in 2017) and the annual HIV incidence (or new infections in a year) is slightly lower (1.1% today vs 1.5% in 2017).

“The LePHIA Final Report released today provides a breadth and depth of data that will greatly inform our approach to controlling Lesotho’s HIV epidemic,” said Hon. Nkaku Kabi, Minister of Health, Government of Lesotho. “The Government of Lesotho is committed to continuing the HIV care and treatment programs that are working and using new data to target gaps in services where we can better meet the needs of all our citizens.”

LePHIA was conducted from November 2016 to May 2017 and included 16,000 people ages 0-59 years across 10,000 randomly selected households. It is the first national survey to provide comprehensive information on important HIV/AIDS indicators at national and regional levels and measure progress toward the globally recognized UNAIDS 90-90-90 targets to be achieved by 2020, which include:

  • 81% of adults who tested HIV positive in LePHIA who already knew their HIV status
  • 92% of those who reported knowing their HIV-positive status who were taking antiretroviral therapy (ART)
  • Among those who reported current use of ART, 88% achieved viral load suppression – a marker of the effectiveness of ART
  • Among children, progress toward 90-90-90 show an estimated 81% of children living with HIV previously diagnosed and 98% of those on ART; however, only 74% had suppressed viral loads

“LePHIA data show Lesotho has made great strides toward achieving the UNAIDS targets and improving care for people living with HIV,” said Koen Frederix, Technical Director, ICAP at Columbia University. “Going forward, the data will enable us in our critical task of identifying and linking to care those infected with HIV but unaware of their status.”

In addition to achieving the UNAIDS targets, LePHIA data also show gaps where Lesotho can focus its efforts:

  • Reduce the number of people living with HIV: Approximately 306,000 people in the country between the ages of 0-59 years, or one out of four, are living with HIV
  • Increase the number of men tested for HIV: Men were less likely than women to report ever having been tested for HIV or to be aware of their prior HIV status
  • Target at-risk age groups: The rate of new infections was highest in females aged 15-24 years and in males it was highest among ages 35-49 years
  • Increase condom use: More than one in three married and/or cohabitating adults who engaged in extra-marital partnerships reported not using condoms
  • Increase access to voluntary male medical circumcision: Only 36.0% of men aged 15-59 years reported having undergone the procedure, an intervention shown to reduce the risk of HIV acquisition

LePHIA data also identified a gap in effectively delivering HIV services to older adolescents and young adults (15-24 years of age):

  • 72% lacked comprehensive knowledge about HIV transmission and prevention, with one in four not knowing that monogamy with an uninfected partner may reduce risk of transmission
  • 40% of those who tested HIV positive had not been previously diagnosed, and if treated only 77% achieved VLS.

With the addition of the LePHIA results, eleven countries have released results from PHIA Project surveys: Cameroon, Cote d’Ivoire, Eswatini, Ethiopia, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe. Data from further assessments in the coming years can be used to assess the progress countries have made since conducting their initial PHIA survey.

The PHIA Project is funded by the U.S. government through PEPFAR and conducted by the Ministries of Health, CDC, ICAP, and other governmental and non-governmental partners. With PEPFAR support, three additional countries – Haiti, Kenya, and Rwanda – will release PHIA data during 2019 and help chart further progress toward epidemic control by 2030.

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The U.S. President’s Emergency Plan for AIDS Relief

PEPFAR is the United States government’s response to the global HIV/AIDS epidemic, which represents the largest commitment by any nation to address a single disease in history. Through the compassion and generosity of the American people, PEPFAR has saved and improved millions of lives, accelerating progress toward controlling and ultimately ending the AIDS epidemic as a public health threat. For more information, please visit www.pepfar.gov, and connect with PEPFAR on Twitter, Facebook, and Instagram.

The U.S. Centers for Disease Control and Prevention

CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. HIV and tuberculosis (TB) are the world’s two most deadly infectious diseases, and CDC’s Division of Global HIV & TB works with partners to tackle these two epidemics and produce the greatest global health impact. More information can be found at http://www.cdc.gov/globalhivtb.

ICAP at Columbia University

ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats, and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs, and over 1.3 million have received antiretroviral therapy through such support.

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

Press Release: Ministry of Health Launches National Survey to Measure the Reach and Impact of Rwanda’s HIV Programs

Press Release

 

Ministry of Health Launches National Survey to Measure the Reach and Impact of Rwanda’s HIV Programs

Rwanda Population-based HIV Impact Assessment (RPHIA) will survey 10,800 households across Rwanda.

Kigali, October 10, 2018

The Ministry of Health announced today the launch of the Rwanda Population-based HIV Impact Assessment (RPHIA). The national household-based survey will measure the reach and impact of Rwanda’s HIV prevention, care, and treatment services across the country. RPHIA is led by the Ministry of Health through the Rwanda Biomedical Centre and the Ministry of Economic Planning and Finance through the National Institute of Statistics of Rwanda in coordination with ICAP at Columbia University and the U.S. Centers for Disease Control and Prevention and support from the U.S. President’s Emergency Plan for AIDS Relief.

“Data collected from RPHIA will provide critical insights on the successes and challenges Rwanda faces in confronting the HIV epidemic. RPHIA participants will benefit from free and confidential HIV testing, counseling, and treatment referrals.”

RPHIA will begin collecting household data on October 12th, 2018 in the Northern Province. The survey is anticipated to last through February 2019. Over the course of five months, trained survey personnel will visit approximately 10,800 randomly selected households and collect demographic, clinical, and behavioral information from consenting participants. Staff will also perform HIV and hepatitis B and C testing.

Results from HIV and hepatitis B virus tests will be returned to participants on the same day, and RPHIA will provide viral load testing for those who test HIV positive. Viral load suppression is a count of how much HIV virus is in the blood and can show if treatment is being used effectively. Participants who test positive for HIV and those selected for hepatitis B and C testing will be referred to health facilities of their choice for further follow up: to receive further counseling and HIV treatment, to receive the vaccine or treatment for hepatitis B, and to receive hepatitis C test results.

The Ministry of Health has led a systematic and sustained response to the HIV epidemic, which includes education on preventing HIV infection as well as universal access to effective HIV medications. Rwanda has intensified HIV testing and treatment strategies and prioritized evidence-based interventions with the goal of achieving epidemic control by 2020.

RPHIA aims to estimate new HIV infections (incidence), number of people living with HIV (prevalence), and viral load suppression among adults and adolescent children. Data collection, laboratory services, and data management will be provided by the Rwanda Biomedical Center in collaboration of the National Institute of Statistics of Rwanda and Westat, Inc. RPHIA includes technical assistance at the national level to strengthen data collection systems, enhance laboratory infrastructure, and strengthen local human resource capacity.

RPHIA will help health authorities and policymakers better understand the impact of HIV on everyone in the population, not only people living with HIV but also their family, friends, and the community at large. The success of the survey and the accuracy of the findings depend on the voluntary participation of all selected households and individuals. The Ministry of Health encourages local leaders, religious leaders, and the press to encourage people, congregations, and followers to consider participating in RPHIA if selected; and to portray a positive and accurate picture of the RPHIA survey to the public.

“RPHIA survey personnel have been extensively trained and are ready to implement a successful survey. It is the mission of all researchers to treat participants with respect, keep their personal information confidential, and ensure they have a positive experience with this important endeavor.”

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ICAP at Columbia University
ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats, and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs, and over 1.3 million have received antiretroviral therapy through such support.

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

Press Release: New Data Show Dramatic Progress in Namibia Toward HIV Epidemic Control and Substantial Gaps in Cote d’Ivoire and Cameroon

Press Release

 

Amsterdam, July 25, 2018

The Government of the Republic of Namibia, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Centers for Disease Control and Prevention (CDC), and ICAP at Columbia University (ICAP) released new data today at the 2018 International AIDS Conference demonstrating that the HIV epidemic is coming under control in Namibia.

Results from the Namibia Population-based HIV Impact Assessment (NAMPHIA) show that 77 percent of all HIV-positive adults in Namibia have achieved viral load suppression, a widely used measure of effective HIV treatment in a population, surpassing the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 73 percent by 2020. Compared with the UNAIDS 2012 estimates, Namibia has reduced its adult HIV incidence rate by 50 percent in the past five years. ‎

Namibia has made this tremendous progress by either reaching or exceeding the UNAIDS 90-90-90 targets among women and, nationally, by attaining 86-96-91 among adults. Namibia accomplished this through the strategic expansion of HIV prevention and treatment services, with a focus on viral load suppression at the individual and community level, and the swift implementation of forward-leading HIV policies.

NAMPHIA results also suggest that women ages 15-24 still have a far higher HIV incidence rate (0.99 percent) than same-aged young men (0.03 percent) in the country. This highlights the continued need for expanded primary HIV prevention in young women, including through the PEPFAR-led DREAMS Partnership, and ensuring all men 25-35 are virally suppressed, such as through the new MenStar Coalition.

“These exciting new data demonstrate that a community-centered approach results in high community viral suppression, which decreases the rates of new HIV infections. Several African countries are now on track to reach HIV epidemic control by 2020, accelerated progress that was only possible because of partner country political leadership and their rapid adoption of policies focusing primary prevention and treatment resources for maximum impact,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “Together, we are making the impossible possible, moving farther and faster toward ending AIDS as a public health threat by 2030.”

“The results of this survey demonstrate the importance of providing innovative, data-driven prevention, care and treatment to those affected by HIV,” said CDC Director Robert Redfield, M.D. “CDC continues to support Namibia’s efforts to control its HIV epidemic – and we remain committed to global efforts to change the course of the HIV pandemic and help save lives.”

The PHIAs evidence important advances being made under the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020). Among the ten countries (Cameroon, Cote d’Ivoire, Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe) that have released PHIA results, Namibia has achieved the highest level of viral load suppression among all HIV-positive adults. Other countries surveyed show varying levels of progress toward reaching the viral suppression target of 73 percent, highlighting key areas for improvement, particularly the need to increase the coverage of HIV testing among adult men, adolescent girls, and young women.

“The impressive findings from the NAMPHIA survey demonstrate the Government of Namibia’s successful commitment to confronting the HIV epidemic,” said Wafaa El-Sadr, MD, MPH, MPA, ICAP global director. “The survey findings also provide a blueprint to guide HIV policies and programs in-country moving forward.”

New data from PHIAs in Cameroon and Cote d’Ivoire released earlier this week highlight substantial gaps in western Africa toward reaching epidemic control despite significant investments, pointing to the depth and breadth of key policy barriers to HIV service uptake that need to be addressed.

Overall, the PHIAs reveal key gaps in HIV prevention and treatment programming for women ages 15-24 and men ages 25-34 that require urgent attention and action. In all countries surveyed, lower percentages of these groups reported knowing their HIV status, current use of HIV treatment, and had viral suppression than older adults. PEPFAR is aggressively addressing these challenges, including through its innovative public-private partnerships.

The PHIAs are funded by the U.S. government, through PEPFAR, and conducted by the CDC, ICAP, and local governmental and non-governmental partners. With PEPFAR support, four additional countries – Ethiopia, Haiti, Kenya, and Rwanda – will release PHIA data on a rolling basis through 2019, providing an ability to chart and validate further progress toward reaching epidemic control by 2020.

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The U.S. President’s Emergency Plan for AIDS Relief
PEPFAR is the United States government’s response to the global HIV/AIDS epidemic, which represents the largest commitment by any nation to address a single disease in history. Through the compassion and generosity of the American people, PEPFAR has saved and improved millions of lives, accelerating progress toward controlling and ultimately ending the AIDS epidemic as a public health threat. For more information, please visit www.pepfar.gov, and connect with PEPFAR on Twitter, Facebook, and Instagram.

The U.S. Centers for Disease Control and Prevention
CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. HIV and tuberculosis (TB) are the world’s two most deadly infectious diseases, and CDC’s Division of Global HIV & TB works with partners to tackle these two epidemics and produce the greatest global health impact. More information can be found at http://www.cdc.gov/globalhivtb.

ICAP at Columbia University
ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats, and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs, and over 1.3 million have received antiretroviral therapy through such support.

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

NEJM Perspective: HIV Population Surveys – Bringing Precision to the Global Response

In a Perspective published in this week’s New England Journal of Medicine, Jessica Justman, Owen Mugurungi, and Wafaa El-Sadr show how Population-based HIV Impact Assessment (PHIA) data provide a robust picture of country-level HIV epidemics, including the gaps in the response, and help guide future actions with precision.

The article explains how PHIA surveys provide direct estimates of critically important measures, such as HIV incidence, population-level viral load suppression (defined as HIV RNA <1000 copies per milliliter), and other essential biomarkers countries and donors need to measure progress. Survey findings have revealed exceptional successes, such as a remarkably high prevalence of viral load suppression among adults living with HIV in three contiguous southern African countries (Malawi, Zambia, and Zimbabwe).

See two new maps: HIV Prevalence and Prevalence of Viral Load Suppression in the NEJM article for a new revealing look at the data (Data in the article, from First Reports and preliminary Summary Sheets, are publically available at phia.icap.columbia.edu).

The article also details the value of repeated surveys, which can reveal trends over time, as demonstrated by comparing results from the Swaziland HIV Incidence Measurement Survey 2 (SHIMS2, 2017) with SHIMS (2011). SHIMS2 data showed a dramatic reduction in HIV incidence (44%) and doubling of population viral load suppression (from 35% to 71% among HIV-positive people aged 18 to 49 years).

The article concludes with an overview of the efforts required to plan and implement population surveys, and a call for more accurate and current population-level data in order to measure progress and guide future policy, programs, and funding decisions with precision. Read the article here.

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Jessica Justman is the Senior Technical Director and PHIA Project Principal Investigator at ICAP at Columbia University; Owen Mugurungi is the Aids and TB Unit director in the Ministry of Health and Child Care, Zimbabwe; Wafaa El-Sadr is the Global Director of ICAP at Columbia University.

From New England Journal of Medicine, Jessica Justman, Owen Mugurungi, Wafaa El-Sadr, HIV Population Surveys – Bringing Precision to the Global Response, 378;20, 1859 Copyright © (2018) Massachusetts Medical Society. Reprinted with permission.

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About the Population-based HIV Impact Assessment Project

The PHIA Project was launched in 2014 to address the need for detailed population HIV measures. Initial findings are already available from seven countries in sub-Saharan Africa (Zimbabwe, Malawi, Zambia, Swaziland, Lesotho, Tanzania, and Uganda), where approximately 200,000 individuals from more than 85,000 households have been surveyed. PHIA surveys are funded by PEPFAR and conducted by ICAP at Columbia University in partnership with ministries of health and the US Centers for Disease Control and Prevention.

PHIA Project at CROI 2018

See below for PHIA Project presentations at the annual Conference on Retroviruses and Opportunistic Infections (CROI) held in Boston, Massachusetts from March 4-7, 2018.

 

Sunday, March 4, 2018

Clinical Trial Design and Analysis Workshop

Measuring Population-Level Impact of Interventions

Jessica Justman, PHIA Project principal investigator and senior technical director at ICAP

Tuesday, March 6, 2018

Oral Presentation

High HIV Burden among Children in Lesotho: Findings from a Population-Based Survey

Kyaw Thin, Ministry of Health, Lesotho

Poster Presentation

High HIV Burden among Children in Lesotho: Findings from a Population-Based Survey

Abstract

Progress Toward 90-90-90: 2016 Lesotho Population-based HIV Impact Assessment Results 

PHIA Project Marks World AIDS Day 2017: Data Available from Seven Countries

On World AIDS Day 2017, the PHIA Project at ICAP at Columbia University, conducted in collaboration with the Centers for Disease Control and Prevention (CDC), announced the release of new data from five survey countries, including preliminary results from Lesotho and Tanzania. With this release, data are now available for seven countries where the population-based HIV impact assessments (PHIAs) were conducted. The release also marks one year since the PHIA Project announced preliminary results from the first three survey countries— Malawi, Zambia, and Zimbabwe—that showed exceptional progress against the HIV epidemic.

PHIA surveys are conducted in collaboration with ministries of health. As part of these surveys, household-based HIV counseling and testing is offered to all household members from selected households by trained survey staff, with return of results. The surveys also ask questions about access to preventive care and treatment services for adults and children. The results measure national and regional progress toward UNAIDS’ 90-90-90 goals and guide policy and funding priorities. Data from the PHIA Project are prepared and disseminated in stages in order to allow the release of preliminary data as soon as possible.

Additionally, today, the PHIA Project posted new First Reports for Malawi, Zambia, and Zimbabwe that present in-depth results on the state of national HIV epidemics by socio-demographics, clinical characteristics, and regions. These 70-page reports also describe design, methods, and response rates and include data on topics such as HIV incidence, prevalence, immune status, achievement of the 90-90-90 targets, prevention of mother-to-child transmission (PMTCT), and sexual behavior.

“The First Reports released today further inform our understanding of the progress made in confronting the HIV epidemic in these three countries,” said Wafaa El-Sadr, M.D., M.P.H., M.P.A., global director of ICAP. “These findings will be crucial in guiding policymakers, researchers, and health officials as they consider the way forward.”

The PHIA Project also released new Summary Sheets detailing preliminary results from two more countries, Lesotho and Tanzania, and updated the Swaziland (SHIMS2) Summary Sheet.

In Lesotho, results show that HIV viral load suppression among all HIV-positive adults —a key marker of the body successfully controlling the virus—has reached over 67 percent among 15- to 59-year olds. This finding suggests that Lesotho is on track to achieve epidemic control by 2020, through reaching the UNAIDS 90-90-90 targets and expanding HIV prevention. Full achievement of the 90-90-90 targets implies achieving a viral load suppression of 73 percent among all people living with HIV.

In Tanzania, HIV viral load suppression among all HIV-positive adults has reached 52%, and researchers noted Tanzania’s progress in reaching people diagnosed with HIV with antiretroviral treatment, care, and support. Data from the survey further indicate Tanzania’s HIV epidemic is stabilizing.

“The collaboration with ministries of health has been fundamental to the success of the PHIA surveys,” said Dr. Jessica Justman, PHIA Project principal investigator and senior technical director at ICAP. “The PHIA findings are eagerly anticipated by the countries as they examine their HIV response to date and their future plans to meet the needs of their citizens.”

ICAP also announced the first publication for the PHIA Project in a supplement issue of the Journal of the International AIDS Society (JIAS). The article describes how the vast majority of viral load results from the first three PHIA surveys were returned to each HIV-positive participant’s preferred health facility within the eight-week target, a significant achievement possible through contributions from partners including ministries of health, CDC, and Westat.

As of December 2017, the PHIA Project has announced preliminary results from seven countries, including Swaziland and Uganda earlier this year. In July, the PHIA Project announced Swaziland’s impressive progress in confronting its HIV epidemic — including nearly halving the rate of new HIV infections — at the International Aids Society 2017 Conference in Paris, France, and spotlighted the stabilization of Uganda’s epidemic during an event hosted by UNAIDS at the UN General Assembly in September 2017.

In the coming months, ongoing surveys in Cameroon, Cote d’Ivoire, Ethiopia, and Namibia will be completed, and surveys will commence in Haiti, Kenya, and Rwanda. The PHIA Project will post additional data in the form of Summary Sheets, Final Reports, and public-access datasets as they become available.

 

About the Population-based HIV Impact Assessment (PHIA) Project

The PHIA Project, led by ICAP at Columbia University in partnership with the US Centers for Disease Control and Prevention (CDC), and funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) measures the reach and impact of HIV programs in PEPFAR-supported countries through national surveys.

 

New PHIA Data Announced as World Leaders Gather in New York to Mark Progress toward Ending AIDS

With world leaders gathered in New York for the UN General Assembly, ICAP at Columbia University—in partnership with PEPFAR and CDC— announced new data on the state of HIV epidemics in Lesotho and Uganda. The data, derived from Population-based HIVImpact Assessment surveys, show remarkable progress in Lesotho and a stabilization of Uganda’s previously expanding epidemic.

In Lesotho, where ICAP conducted LePHIA from November 2016 to May 2017, results show HIV viral load suppression—a key marker of the body successfully controlling the virus—has reached over 67 percent among all HIV-positive adults ages 15-59. This finding suggests that Lesotho is on track to achieve epidemic control by 2020, through reaching the UNAIDS 90-90-90 targets and expanding HIV prevention. Full achievement of 90-90-90 is equal to viral load suppression among 73 percent of all people living with HIV.

In a press conference to announce the results, Deputy Prime Minister Monyane Moleleki confirmed the Lesotho government’s commitment to build on the achievements made and to keep addressing gaps shown in the survey data.

With the announcement of the LePHIA results, five African countries are now approaching control of their HIV epidemics: Lesotho, Malawi, Swaziland, Zambia, and Zimbabwe. In addition, Uganda’s epidemic has likely stabilized due to increases in coverage of voluntary medical male circumcision for HIV prevention, as well as expansion of HIV treatment, including for pregnant women living with HIV.

“With five African countries approaching control of their HIV epidemics, we have the extraordinary opportunity to change the very course of the HIV pandemic over the next three years,” said Ambassador Deborah L. Birx, U.S. global AIDS coordinator and special representative for global health diplomacy.

ICAP’s global director, Dr. Wafaa El-Sadr concurred that the results are cause for optimism, but also note that there is much work still to be done. “These findings show marked progress against HIV in Lesotho and Uganda, but also highlight the need for focused attention as we move forward,” she said. “It is evident that young people, particularly young men under 35 years of age, are reluctant to get tested for HIV, which hinders efforts to stem the spread of this infection. Reaching them is critically important to achieving the ultimate goal of ending this epidemic.”

To mark the progress countries have made toward the 90-90-90 targets and rally momentum around ending AIDS, Ugandan President Yoweri Museveni co-hosted a high-level event with UNAIDS in New York on Thursday, September 21. The event featured heads of state from Guinea, Malawi, Seychelles, Swaziland, Uganda, and Zambia, as well as Ambassador Birx and other distinguished guests.

The immense showing of world leaders spotlighted the energy and resources governments and the international community are focusing on HIV/AIDS. UNAIDS Executive Director Michel Sidibé noted, “Leadership, partnership, and innovation will transform the epidemic.” President Museveni added, “I am confident that working together with you all, we shall attain an AIDS-free Africa. It is possible to end AIDS in our generation!”

Header image: UNAIDS

Press Release: Five African countries approach control of their HIV epidemics as U.S. government launches bold strategy to accelerate progress

Press Release

 

Latest survey results show Lesotho’s significant success with HIV viral load suppression and stabilization of Uganda’s previously expanding epidemic.

Washington, D.C./New York, September 19, 2017— Data released today from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) show that the HIV epidemic is coming under control in Lesotho. These results add to prior PEPFAR-supported Population-based HIV Impact Assessments (PHIAs) announced in the last nine months for Malawi, Swaziland, Zambia, and Zimbabwe.

Together, these data demonstrate impressive progress toward controlling the HIV epidemics in the five countries. The latest data also indicate that the previously expanding epidemic in Uganda has now stabilized. None of these achievements would be possible without the political will and leadership to focus resources for maximum impact in each of these countries.

According to the new Lesotho PHIA results, HIV viral load suppression – a key marker of the body successfully controlling the virus – has reached over 67 percent among all HIV-positive adults ages 15-59. This finding suggests that Lesotho is on track to achieve epidemic control by 2020, through reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets and expanding HIV prevention. Uganda’s epidemic has likely stabilized due to increases in coverage of voluntary medical male circumcision for HIV prevention and expansion of HIV treatment, including for HIV-positive pregnant women.

Building on this progress, U.S. Secretary of State Rex Tillerson today released the new PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020). The Strategy reaffirms the U.S. government’s leadership and commitment, through PEPFAR, to support HIV/AIDS efforts in more than 50 countries, ensuring access to services by all populations, including the most vulnerable and at-risk groups.

The Strategy outlines plans to accelerate implementation in a subset of 13 high-burden countries that have the potential to achieve epidemic control by 2020, working in collaboration with host governments, the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, and other partners. Through this international effort, we expect not only to control the epidemic, but also to reduce the future costs required to sustain the HIV/AIDS response.

“With five African countries approaching control of their HIV epidemics, we have the extraordinary opportunity to change the very course of the HIV pandemic over the next three years,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “We are deeply grateful for Secretary Tillerson’s bold leadership and clear vision in launching this landmark Strategy. PEPFAR is poised to deliver on it, showing that what once seemed impossible is now possible.”

Data from these six countries were gathered through national surveys (PHIAs), which are funded by the U.S. government through PEPFAR, and conducted by the U.S. Centers for Disease Control and Prevention (CDC), ICAP at Columbia University’s Mailman School of Public Health, and local governmental and non-governmental partners. With PEPFAR support, seven additional countries will complete PHIAs on a rolling basis through 2017-2019, providing an ability to chart and validate their respective progress toward reaching epidemic control by 2020.

“CDC is so pleased to contribute to the global HIV response, working with ministries of health and other partners on science-based solutions that are transforming some of the world’s most severe HIV epidemics,” said CDC Director Brenda Fitzgerald, M.D. “National surveys are critical to show the impact of efforts and to chart the path to fully achieve HIV epidemic control.”

While the PHIA results demonstrate tremendous progress, they also reveal key gaps in HIV prevention and treatment programming for younger men and women that require urgent attention and action. In all six surveys, young women and men under age 35 were less likely to know their HIV status, be on HIV treatment, or be virally suppressed than older adults. These gaps are all areas in which PEPFAR will continue to invest and innovate under its new strategy. In particular, PEPFAR will continue to advance efforts to reduce HIV incidence among adolescent girls and young women through the DREAMS Partnership and reach and link more young men to HIV services.

“The findings from the six countries provide a report card on the global and local efforts in confronting the HIV epidemics while at the same time help in shaping a blueprint for their future course as they continue their quest to stem this epidemic,” said Wafaa El-Sadr, M.D., M.P.H., M.P.A., global director of ICAP. “The gaps identified in reaching young women and men are relevant to many other countries around the world, and addressing them is critically important to achieving the ultimate goal of ending this epidemic.”

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About the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
PEPFAR is the U.S. government’s response to the global HIV/AIDS epidemic, which represents the largest commitment by any nation to address a single disease in history. Through the compassion and generosity of the American people, PEPFAR has saved and improved millions of lives, accelerating progress toward controlling and ultimately ending the AIDS epidemic as a public health threat. For more information, please visit www.pepfar.gov, and follow PEPFAR on Twitter, Facebook, and Instagram.

About the U.S. Centers for Disease Control and Prevention (CDC)
CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. HIV and tuberculosis (TB) are the world’s two most deadly infectious diseases, and CDC’s Division of Global HIV & TB works with partners to tackle these two epidemics and produce the greatest global health impact. More information can be found at www.CDC.gov/globalhivtb.

About ICAP at Columbia University
ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats, and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs, and over 1.3 million have received antiretroviral therapy through such support.

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

Major Progress in Confronting HIV in Swaziland Announced at IAS 2017

The Population-based HIV Impact Assessment (PHIA) Project announced major findings from the Swaziland survey at the 9th IAS Conference on HIV Science (July 23-26). Key findings from the second Swaziland HIV Incidence Measurement Survey, SHIMS2, the Swaziland PHIA, revealed impressive progress in confronting the HIV epidemic. Previously released survey results showed similar progress in three high-burden countries: Malawi, Zambia, and Zimbabwe.

The Kingdom of Swaziland has long had a severe HIV epidemic with the world’s highest national HIV prevalence and incidence (rate of new infections). The country has demonstrated a commitment to turning the tide of the epidemic by dramatically scaling up HIV testing and treatment as well as other prevention efforts. Between 2011, when SHIMS1 was conducted, and SHIMS2 in 2016, HIV incidence among adults fell by nearly half (2.5% to 1.4%) and the percentage of HIV-positive adults with viral load suppression (VLS), as a measure of control of the virus, doubled (35% to 71%). HIV prevalence among adults was stable at 30%, similar to the 2011 HIV prevalence of 32%.

“Because of the severe HIV epidemic in Swaziland, it was critical for us to implement a combination HIV prevention package, scale up HIV care and treatment services, and engage in ongoing measurement of HIV incidence in order to assess the impact of these efforts,” said Senator Sibongile Ndlela-Simelane, the honorable Minister of Health, Swaziland. “The results of the SHIMS2 survey reveal a dramatic improvement in the state of the epidemic in Swaziland and we are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.”

Leaders from across global health field expressed enthusiasm over the data. Wafaa El-Sadr, Director of ICAP at Columbia University, called the findings a “cause for celebration,” and Michele Sidibé, Executive Director of UNAIDS, said, “The best news of this conference will be the Swaziland results… The result should drive all our efforts.”

The Swaziland findings echo other PHIA results – released in December 2016 and expanded on through oral abstracts and posters presented at the IAS Conference.

Despite this substantial progress, significant work remains in order to further reach and engage men and young women, particularly around raising awareness of individual’s HIV-positive status and ensuring their access to effective treatment with high adherence.

The nationally representative PHIA surveys, implemented by ICAP in partnership with the US Centers for Disease Control and Prevention (CDC) and the ministries of health with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), provide valuable information on the state of HIV epidemics across Africa and help demonstrate measurable progress toward the UNAIDS 90-90-90 targets. In addition, the results provide further proof of how treatment works for prevention of HIV transmission.

“The partnership with the Swazi Ministry of Health was fundamental to the success of the survey,” said Shannon Hader, MD, MPH, director of the CDC’s Division of Global HIV & TB. “As we’ve seen in other countries, the PHIA findings will help the Ministry of Health and its partners to focus resources on urgent program priorities to achieve epidemic control.”

“We now have clear evidence that four African countries are approaching control of their HIV epidemics,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “These unprecedented findings demonstrate the remarkable impact of the U.S. government’s efforts, through PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, in partnership with African countries. We now have a historic opportunity to change the very course of the HIV pandemic.”

SHIMS2 Summary Sheet: Preliminary Findings, July 2017

Swaziland HIV Incidence Measurement Survey 2: A Population-Based HIV Impact Assessment

The Swaziland HIV Incidence Measurement Survey 2 (SHIMS2) was a household-based national survey conducted between August 2016 and March 2017 to measure the impact of Swaziland’s national HIV response on HIV incidence and viral load suppression. SHIMS2 offered household-based HIV counseling and testing with return of results and collected information about uptake of HIV care and treatment services. This is the second survey to estimate national HIV incidence and viral load suppression. Previous measurements were conducted in SHIMS1 in 2011.

Click the link below to view the results summary sheet.

SHIMS2 Summary Sheet: Preliminary Findings (Updated in November 2017)

Press Release: Swaziland Survey Shows Impressive Progress in Confronting the HIV Epidemic

PRESS RELEASE

 

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

PARIS, July 24, 2017                                 

Key findings from the second Swaziland HIV Incidence Measurement Survey, SHIMS2, reveal impressive progress in confronting the HIV epidemic in the country. Results show a doubling in population viral load suppression since 2011 and a decrease by nearly half in the rate of new HIV infections. The findings were released today at a press conference held by the Prime Minister’s office in Mbabane, Swaziland and at the International Aids Society (IAS) 2017 Conference in Paris, France.

“Because of the severe HIV epidemic in Swaziland, it was critical for us to implement a combination HIV prevention package, scale up HIV care and treatment services, and engage in ongoing measurement of HIV incidence in order to assess the impact of these efforts,” said Senator Sibongile Ndlela-Simelane, the honorable Minister of Health, Swaziland. “The results of the SHIMS2 survey reveal a dramatic improvement in the state of the epidemic in Swaziland and we are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.”

The data come from one of the population-based HIV impact assessment (PHIA) surveys led by the Government of the Kingdom of Swaziland (GKoS) through the Ministry of Health (MOH) and Central Statistical Office (CSO). The survey (SHIMS2) was implemented by ICAP at Columbia University and the US Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR).

SHIMS2 is the second national incidence survey to be conducted in Swaziland, following the 2011 survey (SHIMS1) among adults 18-49 years of age.

In SHIMS2, over 14,000 children and adults participated in this nationally representative survey by agreeing to be interviewed and providing a blood sample for HIV testing.

Key SHIMS2 survey results include:

  • The annual rate of new HIV infections (“HIV incidence”) among adults ages 15 years and older was 1.36 percent: 1.70 percent among females and 1.02 percent among males. Among adults 18-49 years, HIV incidence was 1.39 percent, nearly half of the prior HIV incidence rate in 2011 2.48 percent.
  • The percentage of the adult population living with HIV (“HIV prevalence”) was 27.0 percent: 32.5 percent among females and 20.4 percent among males. The HIV prevalence among adults 18-49 years was 30.5 percent, similar to the 2011 HIV prevalence of 32.1 percent.
  • The percentage of all HIV-positive adults with viral load suppression (VLS), an indication that the infection is under control, was 73.1 percent: 76.0 percent among females and 67.6 percent among males. VLS was estimated using all people living with HIV (PLHIV) as a denominator, regardless of knowing their HIV status or use of antiretroviral drugs. Among all HIV+ adults aged 18-49 years, twice as many had VLS in SHIMS2 as compared to SHIMS1 (71.3 percent compared to 34.8 percent in 2011).
  • The percentage of all HIV-positive adults who knew their HIV status was 84.7%; of these individuals, 87.4% reported current use of antiretroviral treatment and, among those reporting treatment, 91.9 percent had VLS. These results indicate Swaziland has made substantial progress toward achieving all three of the “90-90-90’ targets set by UNAIDS to help end the HIV epidemic.

The progress represented by the findings is attributed to the expansion of HIV testing in the country as well as a substantial increase in the number of HIV-positive individuals on antiretroviral drugs from 2011 to 2016. This is combined with other HIV control interventions expanded in the country.

“These remarkable findings from Swaziland add to the evidence base that we are beginning to control the HIV epidemic in several high-burden countries,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “They both demonstrate our extraordinary progress in ensuring that older HIV-positive adults are on life-saving treatment and virally suppressed as well as reveal key gaps that remain in reaching younger men and women with HIV services.”

“An amazing array of partnerships lasting over a decade – from collaboration within and between governments to coordination across international organizations and implementers – have brought us to an incredible level of success in the work on HIV and AIDS in Swaziland,” said Lisa J. Peterson, US Ambassador to Swaziland. “These partnerships are about people bringing their time and talents together to effect change. Thanks to these joint efforts, the SHIMS 2 data show that many more people will have the opportunity to share their own time and talents with their families and communities. It is especially important that we sustain and strengthen our collective engagement with Swaziland’s youth to ensure that we achieve an AIDS-free generation.”

“The partnership with the Swazi Ministry of Health was fundamental to the success of the survey,” said Shannon Hader, MD, MPH, director of the CDC’s Division of Global HIV & TB. “As we’ve seen in other countries, the PHIA findings will help the Ministry of Health and its partners to focus resources on urgent program priorities to achieve epidemic control.”

“The findings from SHIMS2 are a testimony to the remarkable commitment by the Government of Swaziland in confronting the HIV epidemic,” said Wafaa El-Sadr, MD, MPH, MPA, director of ICAP. “It is a demonstration that all the efforts put into the scale-up of HIV prevention, care and treatment services have borne fruit. ICAP is honored to have played a role in helping to support this successful scale-up.”

“Each Population-based HIV Impact Assessment – PHIA – survey provides a ‘report card’ on how each country is doing in responding to its epidemic as well as a blueprint for future response,” said Jessica Justman, MD, ICAP’s senior technical director and principal investigator of all of ICAP’s PHIA projects, including SHIMS1 and SHIMS2. “Swaziland has made notable progress and is poised to continue making great strides forward with the implementation of test and start and ongoing scale-up of routine viral load monitoring. The SHIMS2 results will help focus efforts and prioritize specific populations in need of urgent attention and innovative approaches.”

Other collaborating governmental entities in Swaziland included the Health Research Unit, Swaziland Health Laboratory Services (SHLS), Swaziland National AIDS Program (SNAP), Health Promotion Unit, Health Management Information System, Environmental Health Department, and National Emergency Response Council on HIV/AIDS (NERCHA).

Additional details on SHIMS2 are available in the summary sheet released by the Swaziland Ministry of Health and the websites for the Ministry of Health www.gov.sz , CDC/PEPFAR www.cdc.gov and www.pepfar.gov, and ICAPs PHIA Project: phia.icap.columbia.edu.

About ICAP at Columbia University

ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs and over 1.3 million have received antiretroviral therapy through such support.

New Population-Based HIV Impact Assessments (PHIA) Show Global Efforts are Helping to Control the HIV Epidemic

Findings from surveys in Swaziland, Zambia, Malawi, and Zimbabwe show remarkable progress toward HIV epidemic control, and confirm that global efforts are helping to curb the HIV epidemic and save lives. These Population-based HIV Impact Assessments (PHIA) are complex, national surveys, supported by CDC through the President’s Emergency Plan for AIDS Relief (PEPFAR), that provide critical information on the state of the HIV epidemic and response in countries affected by the disease. See more in the link below.

New Population-Based HIV Impact Assessments (PHIA) Show Global Efforts are Helping to Control the HIV Epidemic

And learn more at www.CDC.gov.