World-wide South Africa has the largest epidemic of HIV and the biggest anti-retroviral programme. But reaching the UNAIDS 90-90-90 target by 2020 and ending AIDS by 2030 will require an expansion of surveillance and strengthening patient monitoring. Both are needed to monitor progress, identify and correct problems and to demonstrate success. Here we outline the current state of the epidemic and discuss important issues that should inform the National Strategic Plan to be launched on World AIDS Day in December.
The ability to estimate reliable HIV incidence rate ratios (IRRs) using cross-sectional data has vast public health importance in HIV surveillance and in prevention studies; it would reduce the need to recruit and maintain large and costly longitudinal cohorts. In fact, the most common method to evaluate HIV IRR is through cohort studies which are designed to estimate HIV incidence and the effects of interventions. However, the development of biomarkers which identify recently HIV infected individuals has made it possible to estimate HIV incidence using a cross-sectional survey. Following that, one study used classical statistical methods to analyse risk factors of recent HIV infection identified with a biomarker. It is therefore important to determine how that technology can be used to estimate incidence rate ratios.