Towards achieving the end of the HIV epidemic: Advances, challenges and scaling-up strategies

We are entering the 5th decade of the HIV epidemic and although there is no cure, critical advances have been made in treatment, prevention and diagnostics, transforming HIV into a survivable disease. Due to these advances, the UNAIDS has set a goal of "90-90-90" target by 2020, which has been extended now to 2030, to have 90% of individuals infected with HIV diagnosed, 90% of those diagnosed linked to care and 90% of people receiving ART and 90% of those receiving ART achieving an undetectable viral load. Today, the focus is on U = U, "undetectable equals untransmittable", which takes advantage of improved diagnostics and treatment and preventive therapies that are combined with scale-up strategies. This article will review the advances in testing strategies and diagnostics, including rapid diagnostic tests and next generation sequencing, as well as the challenges that pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) now present for diagnosing and managing HIV infection.