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Roselyne Sachiti Features Editor
Zimbabwe could see new HIV infections among 15- to 29-year-olds drop by a third within a decade if the country scales up available prevention tools over the next five years, the second annual Goalkeepers Data Report launched yesterday by The Bill & Melinda Gates Foundation has said.

The introduction of new prevention tools by 2030, including a highly efficacious vaccine, could also further reduce new cases to approximately 400 per year. The good news is together these interventions could avert up to 364 000 new cases of HIV among young people.

Modelling by Imperial College London focused on what Zimbabwe’s HIV epidemic might look like in 2050 and, thus, what the nation’s overall future holds.

Zimbabwe’s large number of young people has the potential to drive economic growth, but only if they remain healthy. More than half of Zimbabweans are under 25 years and are reaching the age when they are most at risk of HIV infection.

The Imperial College London model analysed three alternative scenarios and includes three sets of interventions:

• Treatment: Antiretroviral therapy can be effective, but it depends on three key metrics that go together. Are people aware of their HIV status?

If they are aware, are they on treatment? If they are on treatment, are they adhering to that treatment so that the virus is suppressed in their bodies?

• Currently available prevention methods: This includes condoms; voluntary medical male circumcision (VMMC), which decreases men’s risk of acquiring HIV; and pre-exposure prophylaxis (PrEP), which involves drug treatment for people in high-risk populations, such as sex workers.
• Prevention methods that may be available in the medium and long term: This includes long-acting PrEP and a 70 percent effective vaccine.

Scenario 1: The black line

Status of treatment and prevention

Zimbabwe’s current efforts are impressive. If they are sustained, the number of new infections will continue to decline. However, this decline will be gradual, and there will still be almost 16 000 new infections each year by 2050.

Scenaro 2: The green line

Further scale-up of current prevention tools

The curve would bend sharply if Zimbabwe further scaled up currently available prevention tools over the next five years. New infections would drop by another third within a decade and to roughly 5 000 in 2050, a significant improvement over the status quo scenario. This scenario uses optimistic, but reasonable assumptions for short-term scale-up, based on past trends and coverage levels in nearby countries.

There are two important caveats with this scenario. First, despite the rapid decline in new infections, the virus would remain widely present in 2050, threatening resurgence. More importantly, it would be nearly impossible to sustain this combination of treatment and prevention at such high levels of coverage for 30 years.

Scenario 3: The orange line

Scale-up plus new prevention tools

This is where long-acting PrEP and a vaccine could come in.

“We’re confident that long-acting PrEP, which is not only longer acting, but more effective than current PrEP, will be introduced soon,” the Imperial College London says.

The model assumes in 2024. The model also assumes a vaccine by 2030.

“That’s more optimistic, but it’s why the world (and the Gates Foundation) are investing so much in research and development. If we succeed in introducing these tools, the number of infections would tumble.

“Long acting PrEP and especially a vaccine would also be much easier for a stretched health system to deliver at scale.”

In spite of political and economic disruptions, Zimbabwe has done an exemplary job of controlling HIV. However, this modelling exercise shows that redoubled efforts can make a big difference.

“It’s reasonable to forecast an epidemic that would still sap the strength of Zimbabwean society. It’s also reasonable to forecast an epidemic that is firmly under control.”

But, it depends on Zimbabwe’s continued commitment to ending its HIV crisis. In addition to continuing to invest, Zimbabwe must innovate to reach those most at risk with tools that work for them.

Zimbabwe has just agreed to be one of the leaders of the Global HIV Prevention Coalition, so indications are positive.

Progress also depends on the world’s continued commitment to research and development. A strong pipeline of new and better products, and eventually a vaccine, will ensure that countries like Zimbabwe can succeed.

In a conference call with journalists, Bill Gates said; “The formula of engaging in safe practice, getting yourself tested, if you’re positive, getting on the drugs so that you’re not spreading it to other people. We do have cases, and in our report, we talk specific about Zimbabwe as a place where these programmes have worked, where the message has gotten out and the numbers are coming down. And then we look at if we did the best job, how much further they could be driven down. But you know, it’s all about behaviour and compliance, and how do you get those messages out to that generation?”

Goalkeepers: The Stories Behind the Data 2018 was co-authored and edited by Bill and Melinda Gates and produced in partnership with the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Using new data projections, the report also reveals that poverty within Africa is concentrating in just a handful of countries, which are among the fastest-growing in the world. By 2050, more than 40 percent of the extremely poor people in the world will live in just two countries: Democratic Republic of the Congo and Nigeria.