Downloaded from http://journals.lww.com/co-hivandaids by BhDMf5ePHKbH4TTImqenVL8/J7OdHJl5xBTK35c2gY4fpO+3tu9sddXBnggGGuiRnExLAWFwmZA= on 10/24/2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Global public health efforts to address HIV and related communicable disease syndemics Nathan Ford, Teodora Wi, Philippa Easterbrook, Martina Penazzato, and Marco Vitoria Purpose of review To review recent progress in public health efforts to address HIV, and the extent to which key approaches can be applied to three key epidemics that commonly co-occur with HIV: TB, viral hepatitis, and STIs. Recent findings The public health approach to tackling HIV in low-income and middle-income settings relied on standardized treatment regimens and monitoring approaches, task sharing and community involvement, and decentralized and integrated service delivery. These approaches can all be applied to three key epidemics that commonly co-occur with HIV: TB, viral hepatitis, and STIs. Summary HIV, viral hepatitis, and STIs share common routes of infection, and HIV weakens the immune system, increasing the risk of TB. A public health approach can be applied to address these syndemics. Keywords HIV, sexually transmitted infections, syndemics, tuberculosis, viral hepatitis INTRODUCTION Global efforts to address the HIV/AIDS pandemic have been framed within a public health approach that aims to simplify and standardize treatment and care interventions to support delivery of treatment and care at scale [1]. Key approaches include the use of standardized treatment regimens and monitoring approaches, promote task sharing and community involvement, and implement simplified and inte- grated service delivery. Together these approaches support access to care across the health system and remove barriers to accessing care when relying on specialized staff and resources [2 && ]. The public health approach has enabled 24.5 million people to receive antiretroviral therapy (ART) as of mid-2019 (https:// www.unaids.org/en/resources/fact-sheet). People living with HIV (PLHIV) are at increased risk of acquiring illness from common comor- bidities, such as tuberculosis (TB), viral hepatitis, sexually transmitted infections (STIs), as well as a range of opportunistic infections, because of either shared routes of transmission or increased susceptibility due to immunosuppression. Syn- demics are defined as the aggregation of two or more epidemics in a population that interact to exacerbate the burden and prognosis of both dis- eases [3,4]. In this article, we review recent progress in public health efforts to address HIV, and the extent to which key approaches can be applied to three key epidemics that commonly co-occur with HIV: TB, viral hepatitis, and STIs. THE PUBLIC HEALTH APPROACH TO ADDRESS HIV Standardized treatment regimens and monitoring approaches There are currently over 40 different antiretroviral medicines and combinations approved by the US Food and Drug Administration (FDA) for adults, and multiple dosages for children (https://aidsinfo.nih. gov/understanding-hiv-aids/fact-sheets/21/58/fda- approved-hiv-medicines). This can lead to complex Department of HIV, STIs, and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland Correspondence to Nathan Ford, PhD, FRCPE, Global HIV and Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Tel: +41 22 791 19 49; fax: +41 22 791 21 11; e-mail: fordn@who.int Curr Opin HIV AIDS 2020, 15:261–265 DOI:10.1097/COH.0000000000000636 1746-630X Copyright ß 2020 Wolters Kluwer Health, Inc. All rights reserved. www.co-hivandaids.com REVIEW