Ending the HIV Epidemic by 2030: From Science to Practice

[This text has been written by Anna Saura Lázaro, medical research fellow at ISGlobal, and Denise Naniche, scientific director at ISGlobal]

On December 1, World AIDS Day is commemorated under the theme of “Equalise”. In 2021, it was estimated that more than 15% of the 38 million people living with HIV worldwide were unaware of their status and nearly 30% had no access to treatment. Most of these people live in Sub-Saharan Africa. Indeed, today, poverty-related health inequalities and/or discrimination are the main obstacles to treatment and care for people living with HIV. The world has the science and has effective interventions. However, less than half of these effective interventions are routinely implemented in clinical practice—or if they are, they are not implemented equally. Why?

Less than half of the effective interventions are routinely implemented in clinical practice—or if they are, they are not implemented equally. Why?

Implementation Science

In recent years, the concept of implementation science has gained momentum. This approach aims at translating the results of scientific research to the real world. The goal is to apply a measure that works, for example ─treatment of HIV infection─, using context-specific tools ─community-based treatment delivery─ to get a greater impact ─expanding the reach of treatment for people living with HIV in remote areas. Implementation science seeks to integrate the perspectives of clinical staff, public health practitioners, patients, communities and policy-makers to close the gap between evidence and routine practice.

Does implementation science use rigorous methods? Is it innovative research? The rapid adoption of implementation science in the field of HIV research has been accompanied by the development of robust analytical methods; and, innovation has come from the creativity borne of the union between researchers, stakeholders and community to find equitable solutions. The result: enhanced effectiveness of interventions to diagnose, treat and monitor more people living with HIV in far-from-perfect settings.

Implementation science seeks to integrate the perspectives of clinical staff, public health practitioners, patients, communities and policy-makers to close the gap between evidence and routine practice

With these goals in mind, in implementation science, researchers work not necessarily to develop new interventions, but rather to answer questions about how to apply and adapt interventions that work in specific settings and populations. These questions include understanding the specific health system challenges in delivering interventions, products and new technologies, and addressing them in ways that meet the needs and preferences of the affected populations. The impact of this research is enormous, not in terms of front-page publications, social network prestige or patents but in terms of lives and livelihoods saved. We can succeed in ending the HIV/AIDS epidemic if we work closely with health providers and people living with HIV, involving them in the process of implementing discoveries made by science.

We can succeed in ending the HIV/AIDS epidemic if we work closely with health providers and people living with HIV, involving them in the process of implementing discoveries made by science

Photo: ILRI / Stevie Mann

An Example in the Field of HIV

Mondial Diagnostics, in the Netherlands, together with the Barcelona Institute for Global Health (ISGlobal), the Amsterdam Institute for Global Health and Development (AIGHD) and the Desmond Tutu TB Centre in South Africa, has developed a new rapid point of care test for monitoring whether an individual’s treatment against HIV is working. The test has been developed for use in resource-limited settings where the current monitoring tests, which measure viral load in blood, are scarce or not available due to their high cost and complexity. The test is based on measuring the levels of an immune mediator (Interferon-γ-Inducible Protein 10; IP-10) which is associated with HIV viral load levels in blood.

Initial studies have shown that the point of care test works. The challenge now is to transfer this scientific knowledge to application—i.e. to work on how, when and where this test can bring the greatest benefit to people living with HIV in real-world settings. One such setting is Mozambique, a country where up to 40% of people living with HIV on treatment have little access to tests to find out whether or not their treatment is working. With this challenge in mind, we are launching an implementation science study in conjunction with the Ariel Glaser Paediatric AIDS Foundation—one of the implementers of the national HIV/AIDS programme in Mozambique—as well as the Mozambique Ministry of Health’s national HIV/AIDS programme. Our collective goal is to develop an algorithm for implementing the rapid test in routine clinical practice, focussing on the needs of both the programme and the community. This collaborative effort will gather opinions and initial experiences with the rapid point of care test from people living with HIV, health care workers and key national programme managers. We will work together to identify which populations are likely to benefit the most: people living in isolated areas or people with access to understaffed and/or overburdened health units etc. We will also determine the health delivery context in which the test will be best suited: i.e. community adherence groups, in decentralised clinics, or, more specifically, in people with treatment adherence difficulties. 

We must not only focus on finding a vaccine or cure to end HIV; we must also continue to work to ensure that the tools we already have—and which we know are effective—reach all people equally

In short, to reach the UNAIDS goal of ending the HIV epidemic by 2030, one of the most efficient approaches is to identify relevant interventions from the controlled research world and adapt them to work in different contexts in the real world. We must not only focus on finding a vaccine or cure to end HIV; we must also continue to work to ensure that the tools we already have—and which we know are effective—reach all people equally. In these efforts, implementation science and the affected communities have a vital role to play.