Paper detail

Responding to the AIDS epidemic in Angola

The epidemic of HIV in Angola started later and stabilized at lower levels than elsewhere in southern Africa. With a relatively small population and a high GDP, Angola is in a good position to intervene decisively to control HIV. The effectiveness, availability and affordability of anti-retroviral therapy (ART) make it possible to contemplate ending the epidemic of HIV/AIDS in Angola. We consider what would have happened without ART, the No ART counterfactual, the impact on the epidemic if the current roll-out of ART is maintained, the Current Programme, the impact if coverage is rapidly increased to reach 90% of people with CD4+ cell counts below 350/micro-litre by 2015 and HIV-positive pregnant women are all offered ART for life (Option B+), the Accelerated Programme, and what might be possible under the 2013 guidelines from the World Health Organization, starting in 2015 and reaching full coverage of ART by 2018, the Expanded Programme.If Angola is to reach the 2015 targets in the Presidents Acceleration Plan testing services will need to be expanded. A regular, uninterrupted supply of drugs will have to be assured. Existing health staff will need to be strengthened. Community health workers will need to be mobilized and trained to encourage people to be tested and accept treatment, to monitor progress and to support people on treatment; this in turn will help to reduce stigma and discrimination, loss to follow up of people diagnosed with HIV, and improve adherence for those on treatment. Effective monitoring and evaluation systems will have to be in place and data collection will have to be extended and improved to support the development of reliable estimates of the current and future state of the epidemic, the success of the programme, levels of viral load suppression for those on ART and the incidence of infection.