Opinion Paper

HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential

Erica Parker, Melinda A. Judge, Eusebio Macete, Tacilta Nhampossa, Jienchi Dorward, Denise C. Langa, Caroline De Schacht, Aleny Couto, Paula Vaz, Marco Vitoria, Lucas Molfino, Rachel T. Idowu, Nilesh Bhatt, Denise Naniche, Peter N. Le Souëf
Southern African Journal of HIV Medicine | Vol 22, No 1 | a1237 | DOI: https://doi.org/10.4102/sajhivmed.v22i1.1237 | © 2021 Erica Parker, Melinda A Judge, Eusebio Macete, Tacilta Nhampossa, Jienchi Dorward, Denise Chitsondzo Langa, Caroline De Schacht, Aleny Couto, Paula Vaz, Marco Vitoria, Lucas Molfino, Rachel T Idowu, Nilesh Bhatt, Denise Naniche, Peter N Le Souëf | This work is licensed under CC Attribution 4.0
Submitted: 02 March 2021 | Published: 28 May 2021

About the author(s)

Erica Parker, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
Melinda A. Judge, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
Eusebio Macete, Manhiça Health Research Centre, Manhiça, Mozambique
Tacilta Nhampossa, Manhiça Health Research Centre, Manhiça, Mozambique
Jienchi Dorward, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; and, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
Denise C. Langa, Department of Surveillance, Instituto Nacional de Saúde, Maputo, Mozambique
Caroline De Schacht, Friends in Global Health, Maputo, Mozambique
Aleny Couto, National STI, HIV/AIDS Programme, Ministry of Health, Maputo, Mozambique
Paula Vaz, Fundaçao Ariel Glaser contra o SIDA pediátrico, Maputo, Mozambique
Marco Vitoria, Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
Lucas Molfino, Médecins Sans Frontières, Maputo, Mozambique
Rachel T. Idowu, Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique
Nilesh Bhatt, Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
Denise Naniche, Manhiça Health Research Centre, Manhiça, Mozambique; and, Barcelona Institute for Global Health (ISGlobal), Spain
Peter N. Le Souëf, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia


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Abstract

Background: The burden of HIV is especially concerning for Eastern and Southern Africa (ESA), as despite expansion of test-and-treat programmes, this region continues to experience significant challenges resulting from high rates of morbidity, mortality and new infections. Hard-won lessons from programmes on the ground in ESA should be shared.

Objectives: This report summarises relevant evidence and regional experts’ recommendations regarding challenges specific to ESA.

Method: This commentary includes an in-depth review of relevant literature, progress against global goals and consensus opinion from experts.

Results: Recommendations include priorities for essential research (surveillance data collection, key and vulnerable population education and testing, in-country testing trials and evidence-based support services to improve retention in care) as well as research that can accelerate progress towards the prevention of new infections and achieving ambitious global goals in ESA.

Conclusion: The elimination of HIV in ESA will require continued investment, commitment to evidence-based programmes and persistence. Local research is critical to ensuring that responses in ESA are targeted, efficient and evaluated.


Keywords

HIV epidemiology; public health; risk factors; vulnerable populations; prevention and control; early diagnosis

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