In September, 2015, Stefano Vella published an important commentary in The Lancet HIV on addressing barriers to end the HIV epidemic by 2030.1 An additional barrier that needs to be addressed is to ensure the quality of HIV diagnostic testing as programmes are scaled up. About 150 million children and adults in 129 low-income and middle-income countries reportedly received HIV testing services in 2014.2 Optimistically assuming a 1% error rate (ie, 99% accuracy), a large number of individuals could be wrongly initiated on antiretroviral therapy (ART) as we enter the test-and-treat era while others who need therapy would not receive it. In fact, although diagnostic tests have high sensitivity and specificity, some studies have reported misdiagnosis rates of 2·6–4·8% that occur in HIV testing programme settings.3, 4 | Almost 20 years ago, in 1998, the Office of the High Commissioner for Human Rights (OHCHR) and the Joint UN Programme on HIV/AIDS (UNAIDS) issued the International Guidelines on HIV/AIDS and Human Rights.5 The guidelines emphasised the need for countries to take steps to protect human rights in the context of HIV/AIDS. The epidemic is ever evolving at a rapid pace, and much has happened since the guidelines were adopted: at the time, fewer than 50 000 people with HIV were receiving life-saving ART in developing countries, now more than 17 million are estimated to be on treatment.6 As the global community responds to the prospects of ending the HIV/AIDS epidemic by 2030, UNAIDS has set an ambitious target of 90% of infected individuals being diagnosed, 90% of those being on ART, and 90% of those achieving viral load suppression by 2020.7

Public-private partnerships (PPPs) align public and private needs around mutual goals to move vital projects forward. When PPPs work to strengthen the critical link in the healthcare system, such as laboratory networks, as demonstrated in this supplement by authors from the International Laboratory Branch at the Centers for Disease Control and Prevention (CDC), in-country officials from the respective CDC and Ministries of Health, implementing partners, and Becton, Dickinson, and Company (BD), they significantly change the landscape of healthcare and patient outcomes. | The laboratory networks in African countries supported by a PPP between BD and US President's Emergency Plan for AIDS Relief are achieving a positive transformation. Over the years, the PPP has demonstrated significant contributions in developing a more competent laboratory workforce, reinforced laboratory systems, and improved treatment efficiencies by significantly reducing turnaround time to provide accurate laboratory results to patients afflicted by deadly diseases, such as multidrug resistant tuberculosis and human immunodeficiency virus (HIV). This PPP has not just improved efficiencies in the countries where they exist, it has also provided a successful model for other low-income countries to consider. | The effort needed to meet the UNAIDS 90-90-90 treatment goals to help end the AIDS epidemic by 2020 is tremendous, and neither governments nor the private sector can do it alone. These goals, which state that, by 2020, all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression, are being significantly advanced as a result of this collaboration. We encourage more entities—public, private, health ministries, and nongovernmental organizations—to consider PPPs as an opportunity to efficiently and synergistically meet the needs of people living with HIV/AIDS and of their caregivers.

Although widespread Ebola transmission has been controlled in west Africa, the indirect consequences of the recent epidemic could be yet to fully manifest. In the past 2 years, management of other diseases in Sierra Leone, Liberia and Guinea has been limited as resources were focused on the Ebola response. HIV and tuberculosis programmes were among those affected by workforce depletion, closure of health facilities, and interrupted service and supply chains, leading to a worsening of the region’s HIV and tuberculosis epidemics.1–3 These epidemics were major public health problems in those three countries before the Ebola outbreak: in 2013, 11,200 people died of AIDS-related causes and 7,900 died from tuberculosis. Fewer than two thirds of tuberculosis cases were diagnosed and only 30–57% of eligible people living with HIV were on antiretroviral therapy (ART) – largely due to health system challenges including uncoordinated mobilisation of scarce resources, insufficient staff and laboratory capacity, and inadequate data collection and management.4–7 | Although the Ebola crisis exacerbated many of these problems, it also provides an unprecedented opportunity to assess and address pre-existing and anticipated health challenges in the worst-affected countries. Although there have been multiple calls to heed lessons from the global HIV and tuberculosis responses when addressing Ebola,8–10 we now have a unique chance to transition several elements of the Ebola response to rebuild and strengthen HIV and tuberculosis systems in the region, while sustaining capacity for emergency response.

BACKGROUND: Three cases of pediatric HIV transmission attributed to the feeding practice of premasticating food for children have been reported. The degree of risk that premastication poses for pediatric HIV transmission and the prevalence of this behavior among HIV-infected caregivers is unknown. METHODS: During December 2009-February 2010, we conducted a case-control investigation of late-diagnosed HIV infection in children at six HIV clinics, using in-person and telephone interviews. A cross-sectional investigation of premastication was conducted in concert with this case-control investigation. RESULTS: We compared 11 case-patients to 35 HIV-exposed controls of similar age. Sixteen (35%) of 46 children were fed premasticated food, 10 (22%) by an HIV-infected caregiver. Twenty-seven percent of case-patients received premasticated food from an HIV-infected caregiver compared to 20% of controls (odds ratio = 1.5; 95% confidence interval = 0.3 - 7.1). In the cross-sectional investigation, 48 (31%) of 154 primary caregivers of children aged ≥6 months reported the children received premasticated food from themselves or someone else. The prevalence of premastication decreased with increasing caregiver age, and had been used to feed children aged 1-36 months. CONCLUSIONS: Premastication, a potential route of HIV transmission to children, was a common practice of caregivers. Public health officials and healthcare providers should educate the public about the potential risk of disease transmission via premastication.

BACKGROUND: Increased funding for global human immunodeficiency virus prevention and control in developing countries has created both a challenge and an opportunity for achieving long-term global health goals. This paper describes a programme in Zimbabwe aimed at responding more effectively to the HIV/AIDS epidemic by reinforcing a critical competence-based training institution and producing public health leaders. METHODS: The programme used new HIV/AIDS programme-specific funds to build on the assets of a local education institution to strengthen and expand the general public health leadership capacity in Zimbabwe, simultaneously ensuring that they were trained in HIV interventions. RESULTS: The programme increased both numbers of graduates and retention of faculty. The expanded HIV/AIDS curriculum was associated with a substantial increase in trainee projects related to HIV. The increased number of public health professionals has led to a number of practically trained persons working in public health leadership positions in the ministry, including in HIV/AIDS programmes. CONCLUSION: Investment of a modest proportion of new HIV/AIDS resources in targeted public health leadership training programmes can assist in building capacity to lead and manage national HIV and other public health programmes.