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Despite a concerted international effort in recent decades that has yielded significant progress in the fight against HIV/AIDS, the disease continues to kill large numbers of people, especially in certain regions like rural Ndhiwa district in Homa Bay County, Kenya. Although there is still no definitive cure or vaccine, UNAIDS has set an ambitious goal of ending the epidemic by 2030, specifically via its 90-90-90 (treatment cascade) strategy – namely that 90 per cent of
risk are not left behind’. These accounts from the field describing underlying structural and political constraints when responding to disease outbreaks contrast with a roundtable interview conducted by Elba Rahmouni. The interviewees discuss the political, scientific and operational challenges in a relatively successful HIV project managed by MSF and the Ministry of Health in Ndhiwa, Kenya. In describing the implementation of innovative strategies and care models at the local level