90-90-90 goal towards ending AIDS epidemicJanuary 14, 2019
UNAIDS, the joint United Nations programme on HIV and AIDS, set the target that by the year 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
A UNAIDS advisory panel of global treatment experts conceptualized the 90-90-90 targets based on documented achievements of regional and national programmes in diverse regions of the world.\
At a national level, a growing number of countries are either on track to achieve the 90-90-90 target or have approached, met or exceeded one or more of the elements of the target.
India is only at about 75% of the first 90 and the figures are far below for the second and the third 90s, according to AIDS Society of India, a non-profit organization of doctors and researchers in HIV/AIDS.
Closing treatment gap
The world needs a new, evidence-based HIV treatment narrative that effectively captures the extraordinary expansion of treatment-related knowledge. Rather than focus on a single number (i.e., those receiving HIV treatment), the new target recognises the need to focus on the quality and outcomes of antiretroviral therapy as treatment services are scaled up. These new targets address progress along the HIV cascade of engagement in care, measuring the degree to which programmes are meeting their ultimate goal of viral suppression. It captures both the therapeutic and preventive benefits of HIV treatment
The new targets prioritise equity. The world will not end the AIDS epidemic unless all communities affected by HIV have full and equitable access to life-saving treatment and other prevention services. The ambitious 90-90-90 target demands dramatic progress in closing the treatment gap for children, adolescents and key populations using rights-based approaches.
When complemented by a scale-up of other prevention tools, the target would reduce the annual number of new HIV infections by nearly 90% by 2030. The number of AIDS-related deaths would fall by 80% by 2030 with the achievement of these new post-2015 targets based on available diagnostic and treatment technologies, with the expectation that the likely emergence and uptake of additional medical innovations (such as improved diagnostic tools and longer-acting antiretrovirals) will ensure at least a 90% reduction in AIDS-related deaths by 2030.
Meeting those targets should result in the achievement of the following impact-level interim milestones: by 2020, a reduction of new HIV infections to fewer than 500,000 globally and a reduction in deaths from AIDS-related illness to fewer than 500,000 globally — approximately a 75% reduction in both measures since 2010.
For both HIV incidence and AIDS-related deaths, the envisaged rapid scale-up would result in the sharpest declines between now and 2020, with continued reductions occurring in the following decade as the epidemic’s momentum is progressively depleted, says the UNAIDS document.
Several African countries are either approaching, or within striking distance of, having at least 90% of people living with HIV tested at least once, according to UNAIDS. Although these figures represent a substantial improvement over earlier years, it is estimated that only about 45% of people living with HIV in sub-Saharan Africa know their status.
90% on HIV treatment
High treatment coverage levels have been achieved regionally and nationally in multiple settings, putting them on pace to reach the second prong of the 90-90-90 target if progress continues, UNAIDS says. In countries as diverse as Botswana and Colombia, more than 70% of people diagnosed with HIV infection are currently receiving antiretroviral therapy. In Brazil, more than 60% of people diagnosed with HIV infection were receiving antiretroviral therapy in 2013.
Countries and programmes have also succeeded in achieving high levels of viral suppression, demonstrating the feasibility of a target of 90% viral suppression among all people receiving antiretroviral therapy by 2020. Nationally in Rwanda, for example, 83% of people receiving antiretroviral therapy were found to be virally suppressed after 18 months of therapy in 2008-2009
According to data from 17 countries in Latin America and the Caribbean, the median rate of viral suppression among recipients of HIV treatment is 66%, with more than 80% of individuals receiving antiretroviral therapy having achieved viral suppression in at least five countries (Barbados, Brazil, Honduras, Mexico and Uruguay)