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

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