Coburn, B.J., Okano, J.T., Blower, S. Science Translational Medicine (March 2017), 9(383), pii:eaag0019, doi:10.1126/scitranslmed.aag0019.
The World Health Organization and the Joint United Nations Programme for HIV/AIDS (UNAIDS) have proposed treatment as prevention (TasP) as a global strategy for eliminating HIV by reducing the infectivity of the virus in people living with HIV (PLHIV). The authors of this article developed a geostatistical framework for designing TasP-based HIV elimination strategies in sub-Saharan Africa, focusing on Lesotho, where approximately one-quarter of the population is HIV-positive. By combining several large datasets, they created a map that showed the countrywide geographic dispersion pattern of PLHIV. This map showed that about 20 percent of PLHIV live in urban areas, and that almost all rural communities have at least one HIV-positive individual. Using the map, they then designed an optimal elimination strategy and identified which communities should use TasP. This strategy minimized the area that needed to be covered to find and treat PLHIV. Their findings indicated that UNAIDS's elimination strategy would not be feasible in Lesotho because it would require deploying treatment in areas where there are approximately four HIV-positive individuals/km2. Thus, the spatial dispersion of Lesotho's population hinders, and may even prevent, the elimination of HIV.