Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral t...

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Autores:
Alvis-Guzmán, Nelson
Frank, Tahvi D
Carter, Austin
Jahagirdar, Deepa
Biehl, Molly H
Douwes-Schultz, Dirk
Leigh Larson, Samantha
Arora, Megha
Dwyer-Lindgren, Laura
Steuben, Krista M
Tipo de recurso:
Article of journal
Fecha de publicación:
2019
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
eng
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oai:repositorio.cuc.edu.co:11323/5898
Acceso en línea:
https://hdl.handle.net/11323/5898
https://repositorio.cuc.edu.co/
Palabra clave:
HIV
Mortality
Sida
Antiretroviral therapy
Rights
openAccess
License
CC0 1.0 Universal
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oai_identifier_str oai:repositorio.cuc.edu.co:11323/5898
network_acronym_str RCUC2
network_name_str REDICUC - Repositorio CUC
repository_id_str
dc.title.spa.fl_str_mv Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
title Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
spellingShingle Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
HIV
Mortality
Sida
Antiretroviral therapy
title_short Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
title_full Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
title_fullStr Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
title_full_unstemmed Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
title_sort Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
dc.creator.fl_str_mv Alvis-Guzmán, Nelson
Frank, Tahvi D
Carter, Austin
Jahagirdar, Deepa
Biehl, Molly H
Douwes-Schultz, Dirk
Leigh Larson, Samantha
Arora, Megha
Dwyer-Lindgren, Laura
Steuben, Krista M
dc.contributor.author.spa.fl_str_mv Alvis-Guzmán, Nelson
Frank, Tahvi D
Carter, Austin
Jahagirdar, Deepa
Biehl, Molly H
Douwes-Schultz, Dirk
Leigh Larson, Samantha
Arora, Megha
Dwyer-Lindgren, Laura
Steuben, Krista M
dc.subject.spa.fl_str_mv HIV
Mortality
Sida
Antiretroviral therapy
topic HIV
Mortality
Sida
Antiretroviral therapy
description Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce agesex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact
publishDate 2019
dc.date.issued.none.fl_str_mv 2019-08-19
dc.date.accessioned.none.fl_str_mv 2020-01-22T13:07:59Z
dc.date.available.none.fl_str_mv 2020-01-22T13:07:59Z
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dc.relation.references.spa.fl_str_mv 1 Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015. Lancet 2018; 391: 1799–829.
2 GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736–88.
3 GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789–858.
4 Ghys PD, Williams BG, Over M, Hallett TB, Godfrey-Faussett P. Epidemiological metrics and benchmarks for a transition in the HIV epidemic. PLoS Med 2018; 15: e1002678.
5 Understanding fast-track; accelerating action to end the AIDS epidemic by 2030. Geneva: Joint United Nations Programme on HIV/AIDS, June 2015. http://www.unaids.org/sites/default/files/ media_asset/201506_JC2743_Understanding_FastTrack_en.pdf (accessed July 16, 2019).
6 Murray CJL, Ortblad KF, Guinovart C, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 1005–70.
7 GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1859–922.
8 Stover J, Brown T, Marston M. Updates to the Spectrum/Estimation and Projection Package (EPP) model to estimate HIV trends for adults and children. Sex Transm Infect 2012; 88 (suppl 2): i11–16.
9 Mukolo A, Villegas R, Aliyu M, Wallston KA. Predictors of late presentation for HIV diagnosis: a literature review and suggested way forward. AIDS Behav 2013; 17: 5–30.
10 GBD 2017 Mortality Collaborators. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1684–735.
11 WHO. Global price reporting mechanism for HIV, tuberculosis and malaria. Geneva: World Health Organization. https://www.who.int/ hiv/amds/gprm/en/ (accessed July 16, 2019).
12 McMahon JH, Elliott JH, Bertagnolio S, Kubiak R, Jordan MR. Viral suppression after 12 months of antiretroviral therapy in low- and middle-income countries: a systematic review. Bull World Health Organ 2013; 91: 377–85.
13 Foreman KJ, Marquez N, Dolgert A, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet 2018; 392: 2052–90.
14 Halperin DT, Mugurungi O, Hallett TB, et al. A surprising prevention success: why did the HIV epidemic decline in Zimbabwe? PLoS Med 2011; 8: e1000414.
15 Mabuza K, Dlamini T. History of the HIV epidemic and response in Swaziland. Afr J AIDS Res 2017; 16: v–ix.
16 Grabowski MK, Serwadda DM, Gray RH, et al. HIV prevention efforts and incidence of HIV in Uganda. N Engl J Med 2017; 377: 2154–66.
17 Stover J, Fidzani B, Molomo BC, Moeti T, Musuka G. Estimated HIV trends and program effects in Botswana. PLoS One 2008; 3: e3729.
18 DeHovitz J, Uuskula A, El-Bassel N. The HIV epidemic in eastern Europe and central Asia. Curr HIV/AIDS Rep 2014; 11: 168–76.
19 Zelenev A. Access to opioid agonist therapy in Russia: time for reform. Lancet HIV 2018; 5: e542–43.
20 CDC in Russia: factsheet. Atlanta, GA: Centres for Disease Control and Prevention, 2012. https://www.cdc.gov/globalhealth/countries/ russia/pdf/russia.pdf (accessed July 16, 2019).
21 Vermund SH, Leigh-Brown AJ. The HIV epidemic: high-income countries. Cold Spring Harb Perspect Med 2012; 2: a007195.
22 Sullivan PS, Carballo-Diéguez A, Coates T, et al. Successes and challenges of HIV prevention in men who have sex with men. Lancet 2012; 380: 388–99.
23 HIV in the United States and dependent areas. Atlanta, GA: Centres for Disease Control and Prevention, Jan 29, 2019. https://www.cdc. gov/hiv/statistics/overview/ataglance.html (accessed July 16, 2019).
24 Centers for Disease Control and Prevention (CDC) Prevalence and awareness of HIV infection among men who have sex with men— 21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep 2010; 59: 1201–07.
25 Oster AM, Johnson CH, Le BC, et al. Trends in HIV prevalence and HIV testing among young MSM: five United States cities, 1994–2011. AIDS Behav 2014; 18 (suppl 3): S237–47.
26 Nosyk B, Anglin MD, Brissette S, et al. A call for evidence-based medical treatment of opioid dependence in the United States and Canada. Health Aff (Millwood) 2013; 32: 1462–69.
27 UNAIDS and The African Union. Empower young women and adolescent girls: fast-tracking the end of the AIDS epidemic in Africa. Joint United Nations Programme on HIV/AIDS, 2015. http://www.unaids.org/sites/default/files/media_asset/JC2746_ en.pdf (accessed July 16, 2019).
28 UNAIDS. Ending AIDS. Progress towards the 90-90-90 targets. 2017. https://www.unaids.org/en/resources/documents/2017/20170720_ Global_AIDS_update_2017 (accessed Aug 8, 2019).
29 Birdthistle I, Schaffnit SB, Kwaro D, et al. Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol. BMC Public Health 2018; 18: 912.
30 Krishnaratne S, Hensen B, Cordes J, Enstone J, Hargreaves JR. Interventions to strengthen the HIV prevention cascade: a systematic review of reviews. Lancet HIV 2016; 3: e307–17.
31 Consensus statement: risk of sexual transmission of HIV from a person living with HIV who has an undetectable viral load. Prevention Access Campaign, July 21, 2016. https://www. preventionaccess.org/consensus (accessed July 16, 2019).
32 Kagee A, Remien RH, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: challenges and potential ways forward. Glob Public Health 2011; 6: 83–97.
33 Dwyer-Lindgren L, Cork MA, Sligar A, et al. Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. Nature 2019; 570: 189–93.
34 Integration of HIV/TB services. UNAIDS, 2012. https://www.unaids.org/sites/default/files/20120323_infographic_ TB.pdf (accessed July 16, 2019).
35 Gupta RK, Gregson J, Parkin N, et al. HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis. Lancet Infect Dis 2018; 18: 346–55.
36 HIV estimates with uncertainty bounds 1990–2018. UNAIDS, July 16, 2019. http://www.unaids.org/en/resources/ documents/2019/HIV_estimates_with_uncertainty_bounds_1990present (accessed Aug 13, 2019).
37 Johnson L, Dorrington R. Thembisa version 4.1: a model for evaluating the impact of HIV/AIDS in South Africa. Thembisa, August, 2018.
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spelling Alvis-Guzmán, NelsonFrank, Tahvi DCarter, AustinJahagirdar, DeepaBiehl, Molly HDouwes-Schultz, DirkLeigh Larson, SamanthaArora, MeghaDwyer-Lindgren, LauraSteuben, Krista M2020-01-22T13:07:59Z2020-01-22T13:07:59Z2019-08-190140-67361474-547Xhttps://hdl.handle.net/11323/5898Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce agesex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impactAlvis-Guzmán, Nelson-will be generated-orcid-0000-0001-9458-864X-600Frank, Tahvi DCarter, AustinJahagirdar, DeepaBiehl, Molly HDouwes-Schultz, DirkLeigh Larson, SamanthaArora, MeghaDwyer-Lindgren, LauraSteuben, Krista MengThe Lancethttps://doi.org/10.1016/S2352-3018(19)30196-11 Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015. Lancet 2018; 391: 1799–829.2 GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736–88.3 GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789–858.4 Ghys PD, Williams BG, Over M, Hallett TB, Godfrey-Faussett P. Epidemiological metrics and benchmarks for a transition in the HIV epidemic. PLoS Med 2018; 15: e1002678.5 Understanding fast-track; accelerating action to end the AIDS epidemic by 2030. Geneva: Joint United Nations Programme on HIV/AIDS, June 2015. http://www.unaids.org/sites/default/files/ media_asset/201506_JC2743_Understanding_FastTrack_en.pdf (accessed July 16, 2019).6 Murray CJL, Ortblad KF, Guinovart C, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 1005–70.7 GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1859–922.8 Stover J, Brown T, Marston M. Updates to the Spectrum/Estimation and Projection Package (EPP) model to estimate HIV trends for adults and children. Sex Transm Infect 2012; 88 (suppl 2): i11–16.9 Mukolo A, Villegas R, Aliyu M, Wallston KA. Predictors of late presentation for HIV diagnosis: a literature review and suggested way forward. AIDS Behav 2013; 17: 5–30.10 GBD 2017 Mortality Collaborators. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1684–735.11 WHO. Global price reporting mechanism for HIV, tuberculosis and malaria. Geneva: World Health Organization. https://www.who.int/ hiv/amds/gprm/en/ (accessed July 16, 2019).12 McMahon JH, Elliott JH, Bertagnolio S, Kubiak R, Jordan MR. Viral suppression after 12 months of antiretroviral therapy in low- and middle-income countries: a systematic review. Bull World Health Organ 2013; 91: 377–85.13 Foreman KJ, Marquez N, Dolgert A, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet 2018; 392: 2052–90.14 Halperin DT, Mugurungi O, Hallett TB, et al. A surprising prevention success: why did the HIV epidemic decline in Zimbabwe? PLoS Med 2011; 8: e1000414.15 Mabuza K, Dlamini T. History of the HIV epidemic and response in Swaziland. Afr J AIDS Res 2017; 16: v–ix.16 Grabowski MK, Serwadda DM, Gray RH, et al. HIV prevention efforts and incidence of HIV in Uganda. N Engl J Med 2017; 377: 2154–66.17 Stover J, Fidzani B, Molomo BC, Moeti T, Musuka G. Estimated HIV trends and program effects in Botswana. PLoS One 2008; 3: e3729.18 DeHovitz J, Uuskula A, El-Bassel N. The HIV epidemic in eastern Europe and central Asia. Curr HIV/AIDS Rep 2014; 11: 168–76.19 Zelenev A. Access to opioid agonist therapy in Russia: time for reform. Lancet HIV 2018; 5: e542–43.20 CDC in Russia: factsheet. Atlanta, GA: Centres for Disease Control and Prevention, 2012. https://www.cdc.gov/globalhealth/countries/ russia/pdf/russia.pdf (accessed July 16, 2019).21 Vermund SH, Leigh-Brown AJ. The HIV epidemic: high-income countries. Cold Spring Harb Perspect Med 2012; 2: a007195.22 Sullivan PS, Carballo-Diéguez A, Coates T, et al. Successes and challenges of HIV prevention in men who have sex with men. Lancet 2012; 380: 388–99.23 HIV in the United States and dependent areas. Atlanta, GA: Centres for Disease Control and Prevention, Jan 29, 2019. https://www.cdc. gov/hiv/statistics/overview/ataglance.html (accessed July 16, 2019).24 Centers for Disease Control and Prevention (CDC) Prevalence and awareness of HIV infection among men who have sex with men— 21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep 2010; 59: 1201–07.25 Oster AM, Johnson CH, Le BC, et al. Trends in HIV prevalence and HIV testing among young MSM: five United States cities, 1994–2011. AIDS Behav 2014; 18 (suppl 3): S237–47.26 Nosyk B, Anglin MD, Brissette S, et al. A call for evidence-based medical treatment of opioid dependence in the United States and Canada. Health Aff (Millwood) 2013; 32: 1462–69.27 UNAIDS and The African Union. Empower young women and adolescent girls: fast-tracking the end of the AIDS epidemic in Africa. Joint United Nations Programme on HIV/AIDS, 2015. http://www.unaids.org/sites/default/files/media_asset/JC2746_ en.pdf (accessed July 16, 2019).28 UNAIDS. Ending AIDS. Progress towards the 90-90-90 targets. 2017. https://www.unaids.org/en/resources/documents/2017/20170720_ Global_AIDS_update_2017 (accessed Aug 8, 2019).29 Birdthistle I, Schaffnit SB, Kwaro D, et al. Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol. BMC Public Health 2018; 18: 912.30 Krishnaratne S, Hensen B, Cordes J, Enstone J, Hargreaves JR. Interventions to strengthen the HIV prevention cascade: a systematic review of reviews. Lancet HIV 2016; 3: e307–17.31 Consensus statement: risk of sexual transmission of HIV from a person living with HIV who has an undetectable viral load. Prevention Access Campaign, July 21, 2016. https://www. preventionaccess.org/consensus (accessed July 16, 2019).32 Kagee A, Remien RH, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: challenges and potential ways forward. Glob Public Health 2011; 6: 83–97.33 Dwyer-Lindgren L, Cork MA, Sligar A, et al. Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. Nature 2019; 570: 189–93.34 Integration of HIV/TB services. UNAIDS, 2012. https://www.unaids.org/sites/default/files/20120323_infographic_ TB.pdf (accessed July 16, 2019).35 Gupta RK, Gregson J, Parkin N, et al. HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis. Lancet Infect Dis 2018; 18: 346–55.36 HIV estimates with uncertainty bounds 1990–2018. UNAIDS, July 16, 2019. http://www.unaids.org/en/resources/ documents/2019/HIV_estimates_with_uncertainty_bounds_1990present (accessed Aug 13, 2019).37 Johnson L, Dorrington R. Thembisa version 4.1: a model for evaluating the impact of HIV/AIDS in South Africa. 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