Evidence map›Paper›PMID 41217420›Full record

ArticleAIDS (London, England)2026

Evaluating the impact of achieving cascade equality in Eswatini: a modeling study on the prevention impacts of antiretroviral therapy.

Jesse Knight, Huiting Ma, Bheki Sithole, Lungile Khumalo, Linwei Wang, Sheree Schwartz, Laura Muzart, Sindy Matse, Zandile Mnisi, Rupert Kaul and 3 more

Abstract read
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Article in AIDS (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Jesse KnightMAP Centre for Urban Health Solutions, Unity Health Toronto.
Huiting MaMAP Centre for Urban Health Solutions, Unity Health Toronto.
Bheki SitholeEpiC, FHI 360.
Lungile KhumaloVoice of Our Voices, Eswatini.
Linwei WangMAP Centre for Urban Health Solutions, Unity Health Toronto.
Sheree SchwartzBloomberg School of Public Health, Johns Hopkins University, USA.
Laura MuzartEpiC, FHI 360.
Sindy MatseMinistry of Health, Eswatini.
Zandile MnisiMinistry of Health, Eswatini.
Rupert KaulDivision of Infectious Diseases, Department of Medicine.
Michael EscobarDalla Lana School of Public Health, University of Toronto.
Stefan BaralBloomberg School of Public Health, Johns Hopkins University, USA.
Sharmistha MishraMAP Centre for Urban Health Solutions, Unity Health Toronto.

Funding

Leveraging Big Data Science to Focus the HIV Response in Countries with Generalized HIV EpidemicsR01AI170249 · NIAID · JOHNS HOPKINS UNIVERSITY · PI BARAL, STEFAN DAVID · 2022 to 2025
$2.9M
NIAID NIH HHS R01 AI170249
6 · The paper itself

Abstract

objectiveInequalities in the antiretroviral therapy (ART) cascade across subpopulations remain an ongoing challenge in the global HIV response. Eswatini achieved the UNAIDS 95-95-95 ART cascade targets by 2020, with differentiated programs to minimize inequalities across subpopulations, including for female sex workers (FSWs) and their clients. We sought to estimate the impacts of this achievement, through a retrospective impact evaluation of ART scale-up in Eswatini.

designDrawing on population-level and FSW-specific surveys, we developed a compartmental model of heterosexual HIV transmission, and calibrated it to observed HIV prevalence, incidence, and ART cascade scale-up in Eswatini.

methodsWe defined four counterfactual scenarios in which the population overall reached only 80-80-90 by 2020, but where FSW, clients, both, or neither were disproportionately left behind, reaching only 60-40-80. We estimated additional HIV infections by 2020 in counterfactual vs. observed scenarios, and identified epidemic conditions which maximized differences.

resultsCompared with observed cascade scale-up in Eswatini, leaving behind neither FSW nor their clients led to median (95% confidence interval, 95% CI) 8.8 (6.3-10.9) additional infections by 2020 vs. 14.3 (10.8-18.6) if both were left behind, a 63 (31-128) increase. The impact of leaving behind FSW and/or clients was largely determined by their population sizes and HIV incidence ratio among clients vs. men overall.

conclusionInequalities in the ART cascade across subpopulations can undermine the anticipated prevention impacts of cascade scale-up. As Eswatini has shown, addressing inequalities in the ART cascade that intersect with transmission risk can maximize incidence reductions from cascade scale-up.

Indexed as

Anti-Retroviral AgentsDisease Transmission, InfectiousHIV InfectionsAdolescentAdultEswatiniFemaleHumansIncidenceMaleMiddle AgedPrevalenceRetrospective StudiesSex WorkersYoung AdultAnti-Retroviral Agentsantiretroviral therapyhealthcare disparitiesHIVmathematical modelsex workSouthern Africa

Identifiers

PMID41217420
PMCPMC12863613

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.