I-101 Public health approach to HIV stagnation

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Progress in HIV care since the report of triple therapy in 1996 is undeniable and we now speak frequently of cure and vaccine. The reality is that despite good treatment and prevention, there continues to be about 50,000 new cases/yr, about 14% are undiagnosed, and those infected have a lifetime of meds. Tom Frieden, Director of the CDC, notes the great contribution of failed communication between experts in public health and those doing primary HIV-care: different thought leaders, journals, meetings and funding streams. His plea is to focus efforts on two groups that account for the vast majority of new cases: young MSM and patients who had fallen out of care. The former group needs aggressive HIV testingpreferrably NAT testing to detect acute infection especially when most contagious; the latter group needs appropriate incentives ($) to retain patients in care. An example using $1000/yr/patient would be enormously cost effective. Other methods to be suggested include: use of encrypted social media to improve compliance, use of new long acting ART and implementation of PrEP which has performed well in trials but failed with implementation. The bottom line in this effort includes a novel collaboration between HIV public health experts in care providers to rethink the way we do care and pay for care.

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