Towards achieving the end of the HIV epidemic: Advances, challenges and scaling-up strategies

Abstract

We are entering the 5th decade of the HIV epidemic and although there is no cure, critical advances have been made in treatment, prevention and diagnostics, transforming HIV into a survivable disease. Due to these advances, the UNAIDS has set a goal of “90–90–90” target by 2020, which has been extended now to 2030, to have 90% of individuals infected with HIV diagnosed, 90% of those diagnosed linked to care and 90% of people receiving ART and 90% of those receiving ART achieving an undetectable viral load. Today, the focus is on U = U, “undetectable equals untransmittable”, which takes advantage of improved diagnostics and treatment and preventive therapies that are combined with scale-up strategies. This article will review the advances in testing strategies and diagnostics, including rapid diagnostic tests and next generation sequencing, as well as the challenges that pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) now present for diagnosing and managing HIV infection.