Redefining HIV care: a path toward sustainability post-UNAIDS 95-95-95 targets

In 2021, around 38 million people were living with HIV (PLHIV) globally. In the same year, the number of new HIV infections worldwide was 1.5 million, while 650,000 died from AIDS-related illnesses (1). Low and middle-income nations (LMICs), especially those in sub-Saharan Africa (SSA), have been hardest hit by the HIV epidemic. Apart from the death toll, the epidemic severely impacted LMICs' health systems. The HIV epidemic led to a shortage of healthcare workers (HCWs) in LMICs due to death and absenteeism from work as a result of HIV-related illnesses, especially in the years before the introduction of antiretroviral treatment (ART) (2). Before ART, opportunistic diseases such as cryptococcal meningitis, diarrhoeal disorders, and tuberculosis significantly increased the demand for healthcare. As patients stayed in hospitals longer due to opportunistic infections, the need for hospital beds increased (3). The increased demand for healthcare also led to an increase in overall healthcare costs. In many countries, especially the LMICs, the health expenditure on HIV escalated, which had a knock-on effect, reducing spending on non-HIV diseases (4).