CONCENTRATED EPIDEMICS: Edited by Sheena McCormack, Rachel Baggaley and Kevin M. DeCockThe arc of HIV epidemics in sub-Saharan Africa new challenges with concentrating epidemics in the era of 90–90–90Ortblad, Katrina F.a; Baeten, Jared M.a,b,c; Cherutich, Peterd; Wamicwe, Joyce Njerid; Wasserheit, Judith N.a,b,c,eAuthor Information aDepartment of Global Health bDepartment of Medicine cDepartment of Epidemiology, University of Washington, Seattle, Washington, USA dKenya Ministry of Health, Nairobi, Kenya eFred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA Correspondence to Katrina F. Ortblad, Sc.D., MPH, International Clinical Research Center, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA. Tel: +1 206 520 3800; e-mail: [email protected] Current Opinion in HIV and AIDS: September 2019 - Volume 14 - Issue 5 - p 354-365 doi: 10.1097/COH.0000000000000569 Buy Metrics Abstract Purpose of review The aim of this review is to examine the emerging results from the HIV universal test and treat (UTT) cluster-randomized trials in sub-Saharan Africa, discuss how expanding access to HIV clinical services is likely to reshape the arc of HIV epidemics, and consider implications for HIV prevention and control strategies in the coming decade. Recent findings The effect of universal HIV testing followed by immediate antiretroviral treatment (ART) on community-level HIV incidence remains unclear upon completion of five randomized trials. Only two of the four trials that measured HIV incidence found significant reductions in community-level incidence. Even in these trials, HIV incidence remained above levels required for epidemic control (≤1 case per 1000 person-years) despite high levels of ART coverage and viral suppression. These findings may indicate that community-delivered HIV services are not reaching the high-frequency transmitters who sustain HIV epidemics and are likely members of marginalized or hard to engage core groups. Summary With expanded access to HIV services in sub-Saharan Africa, HIV epidemics are transitioning from hyperendemic to declining/endemic epidemic phases, characterized increasingly by the reconcentration of HIV in marginalized or hard to engage core groups. To move toward epidemic control, novel HIV service delivery models and technologies are needed to engage those who continue to drive HIV incidence in this new epidemic phase. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.