Current Approaches to HIV Control: Status, Contribution of Sub-Saharan Africa and Proposal of an Additional Innovative Alternative: Lutte Contre le VIH en Afrique Subsaharienne : Évaluation des Stratégies Actuelles et Proposition d’une Approche Communautaire Intégrée « Test-Traiter-Éduquer-Maintenir » (T²EM)

Abstract

Background: Sub-Saharan Africa bears the heaviest global burden of HIV. Despite significant progress in the prevention-testing-treatment triad, persistent challenges hinder the achievement of elimination targets. Objective: To analyze the strengths and limitations of current HIV control strategies in Sub-Saharan Africa and to propose a complementary alternative focused on systemic community strengthening. Methodology: This article is a critical narrative review of scientific literature and programmatic reports from the last 10 years, focused on the sub-Saharan context. Results: Current strategies (ART, PrEP, PMTCT) are effective but face structural barriers: weak health systems, stigma, socio-economic challenges, and difficulties in retention in the care continuum. SSA's role in the global response is crucial and innovative (e.g., task-shifting models), but remains insufficiently supported. Proposal: We propose the "Test-Treat-Educate-Maintain" (T²EM) model, an integrated and decentralized approach rooted in communities. It is based on 1) strengthening self-testing and community-based testing, 2) ultra-rapid ART initiation via community health workers, 3) peer-led education cycles focused on adherence and combined prevention, and 4) a maintenance system using simplified digital follow-up (SMS) and support groups. Conclusion: The T²EM model aims to complement national strategies by improving patient accessibility, acceptability, and retention. Its implementation requires strengthened partnership between national programs, communities, and local researchers for operational evaluation.