Grant: Project Grant

Ending the AIDS epidemic begins by building efficient HIV testing services. HIV testing has, and remains, a cornerstone of HIV prevention efforts. A positive diagnosis entails that people living with HIV can receive life-saving antiretroviral therapy and, if the test is negative, people vulnerable to HIV acquisition can be identified and linked to prevention services. The Joint United Nations Programme on HIV/AIDS (UNAIDS) put forward the objective of ending the AIDS epidemic by 2030 by strengthening the HIV care cascade. The proportion of people living with HIV aware of their status is a key progress indicator and common bottleneck in the cascade. Tracking this indicator in sub-Saharan Africa is difficult, however, as surveillance systems are often incomplete. Our team has recently developed tailored tools that specifically address these challenges. Yet, current models are agnostic about testing modalities (e.g., opt-in, HIV self-tests, mobile campaigns) and cannot stratify coverage metrics by key populations (e.g., female sex workers and men who have sex with men). Members of these populations represent close to 50% of global new HIV infections and, if the goal of ending AIDS is to be achieved, they need explicit consideration. To fill these knowledge gaps, we will develop methods, build tools, and validate models to inform, strengthen, and optimize HIV testing services. Specifically, we will 1) improve estimates by integrating new data sources, 2) adapt current frameworks to consider key populations, and 3) optimize national HIV testing strategies considering affordability and cost-effectiveness. By drawing on the expertise of an international team of HIV researchers, biostatisticians, economists, modelers, and knowledge users, our project will guide global recommendations on how best to sustainably close gaps in diagnosis coverage among some of sub-Saharan Africa's most vulnerable groups.