PhD defence C.A. (Caroline) Bulstra

Summary: The HIV pandemic has been one of the most devastating public health threats in recent history. After emerging as a new human pathogen during the mid-20th century, the virus spread rapidly, infecting over 79 million people worldwide, of whom 36 million have died due to its consequences. In the late 1990s, HIV-related mortality peaked worldwide, with over 2 million deaths annually. The pandemic was especially severe in sub-Saharan Africa, where over 10% of the population was infected in many countries, and high mortality rates had altogether reduced life expectancies. However, scientific breakthroughs coupled with an unprecedented global effort to control the pandemic have substantially expanded worldwide access to a wide range of biomedical and behavioural interventions to treat and prevent HIV infection, sparking optimism that the end of the pandemic could be in sight. Nowadays, about 75% of all people living with HIV worldwide are receiving life-saving treatment, even in the poorest countries of the world, and the number of new infections has been declining tremendously. In a landmark General Assembly on HIV/AIDS in 2016, the United Nations endorsed the ambitious commitment to end the pandemic by 2030. While progress towards this noble endeavour has been substantial, many obstacles still exist in reaching sustainable control of the pandemic. This thesis presents scientific research on the epidemiology of HIV and the potential of health systems innovations, which might contribute to overcoming some of these obstacles, and thereby help to ensure that we are truly living in the last decade of HIV.