Background: In 2011 an Investment Framework was proposed that described how the scale-up of key HIV interventions
could dramatically reduce new HIV infections and deaths in low and middle income countries by 2015. This framework
included ambitious coverage goals for prevention and treatment services resulting in a reduction of new HIV infections by
more than half. However, it also estimated a leveling in the number of new infections at about 1 million annually after 2015.
Methods: We modeled how the response to AIDS can be further expanded by scaling up antiretroviral treatment (ART)
within the framework provided by the 2013 WHO treatment guidelines. We further explored the potential contributions of
new prevention technologies: ‘Test and Treat’, pre-exposure prophylaxis and an HIV vaccine.
Findings: Immediate aggressive scale up of existing approaches including the 2013 WHO guidelines could reduce new
infections by 80%. A ‘Test and Treat’ approach could further reduce new infections. This could be further enhanced by a
future highly effective pre-exposure prophylaxis and an HIV vaccine, so that a combination of all four approaches could
reduce new infections to as low as 80,000 per year by 2050 and annual AIDS deaths to 260,000.
Interpretation: In a set of ambitious scenarios, we find that immediate implementation of the 2013 WHO antiretroviral
therapy guidelines could reduce new HIV infections by 80%. Further reductions may be achieved by moving to a ‘Test and
Treat’ approach, and eventually by adding a highly effective pre-exposure prophylaxis and an HIV vaccine, if they become
available.