Treating all people living with HIV in sub-Saharan Africa: a new era calling for new approaches

Nearly all countries in sub-Saharan Africa (SSA) have adopted national policies to treat all persons with HIV, regardless of CD4 cell count or clinical stage (‘treat all’). With 10.3 million people untreated and a projected 1.2 million new infections per year in SSA, the current and anticipated unmet need for HIV treatment in SSA is substantial. Evidence to date from SSA suggests that, once linked to care, timely ART initiation with retention and viral suppression is the norm. However, ART initiation in SSA usually occurs late in the course of infection, driving high mortality and incidence rates. The ‘treat all’ era presents strategic opportunities for health systems to substantially reduce AIDS-related mortality and HIV incidence. This special issue of the Journal of Virus Eradication contains eight articles focused on issues critical to ensuring the success and impact of ‘treat all’ implementation in SSA.