UNAIDS 90–90–90 targets to end the AIDS epidemic by 2020 are not realistic: comment on “Can the UNAIDS 90–90–90 target be achieved? A systematic analysis of national HIV treatment cascades”

Bain, Luchuo Engelbert; Nkoké, Clovis; Noubiap, Jean Jacques

doi:10.1136/bmjgh-2016-000227

Cited by 146 publications

(129 citation statements)

References 12 publications

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…Cameroon has adhered to the strategic Objectives 90-90-90 of United Nations Program on HIV/AIDS (UNAIDS) [6], which aims to increase HIV testing to 90%, achieve ART coverage of 90% and 90% of people on antiretroviral therapy (ART) achieve viral suppression by 2020. Therapeutic Education (TE), process of acquiring abilities and skills that help the patient to live optimally with his illness, is one of the strategies proposed by achieve viral suppression [7].…”

Section: Introductionmentioning

confidence: 99%

Impact of Therapeutic Education on the Viral Load of HIV Infected Children and Adolescents on Antiretroviral Therapy at the Douala Laquintinie Hospital, Cameroon

Penda¹,

Bissek²,

Bilong³

et al. 2019

IJCM

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Impact of Therapeutic Education on the Viral Load of HIV Infected Children and Adolescents on Antiretroviral Therapy at the Douala Laquintinie Hospital, Cameroon

Penda¹,

Bissek²,

Bilong³

et al. 2019

IJCM

View full text Add to dashboard Cite

“…However, this will only be possible with progress in the first stage in the HIV care cascade, the 90% diagnosis target, as even a small number of undiagnosed people could sustain an epidemic . Also, other stages of the HIV care continuum not directly measured in the 90‐90‐90 scheme are important to reach the UNAIDS target, such as linking diagnosed HIV‐positive patients to services and ensuring sustained and appropriate care, like switching to second‐line therapy regimens when necessary . Indeed, we found increased access to ART and viral suppression in stronger health systems, which are likely to provide better retention within the system because of increased availability, accessibility and affordability of services.…”

Section: Discussionmentioning

confidence: 84%

“…Some argued that expanding ART might create a false sense of security among those affected, perversely encouraging greater rates of unsafe sex , which has been contested . Others highlighted constraints to scaling up treatment as a result of limited resources, especially in low‐income settings , uncertainty about the use of data from clinical trials that showed ‘modest benefits’ , nonreplicability at the community level , and the risk of increasing rates of adverse effects caused by ART and resistance .…”

Section: Introductionmentioning

confidence: 99%

Population uptake and effectiveness of test‐and‐treat antiretroviral therapy guidelines for preventing the global spread of HIV: an ecological cross‐national analysis

Mendez‐Lopez

Stuckler

Granich³

et al. 2019

HIV Medicine

View full text Add to dashboard Cite

Objectives Although the benefits of adopting test‐and‐treat antiretroviral therapy (ART) guidelines that recommend initiation of ART regardless of CD4 cell counts have been demonstrated at the individual level, there is uncertainty about how this translates to the population level. Here, we explored whether adopting ART guidelines recommending earlier treatment initiation improves population ART access and viral suppression and reduces overall disease transmission. Methods Data on ART initiation guidelines and treatment coverage, viral suppression, and HIV incidence from 37 European and Central Asian countries were collected from the European Centre for Disease Prevention and Control and the Global HIV Policy Watch and HIV 90‐90‐90 Watch databases. We used multivariate linear regression models to quantify the association of ART initiation guidelines with population ART access, viral suppression, and HIV incidence, adjusting for potential confounding factors. Results Test‐and‐treat policies were associated with 15.2 percentage points (pp) [95% confidence interval (CI) 0.8–29.6 pp; P = 0.039] greater treatment coverage (proportion of HIV‐positive people on ART) compared with countries with ART initiation at CD4 cell counts ≤ 350 cells/μL. The presence of test‐and‐treat policies was associated with 15.8 pp (95% CI 2.4–29.1 pp; P = 0.023) higher viral suppression rates (people on ART virally suppressed) compared with countries with treatment initiation at CD4 counts ≤ 350 cells/μL. ART initiation at CD4 counts ≤ 500 cells/μL did not significantly improve ART coverage compared to initiation at CD4 counts ≤ 350 cells/μL but achieved similar degrees of viral suppression as test‐and‐treat. Conclusions Test‐and‐treat was found to be associated with substantial improvements in population‐level access to ART and viral suppression, further strengthening evidence that rapid initiation of treatment will help curb the spread of HIV.

show abstract

“…With an increasing number of elderly PLHIV, integration with chronic disease services would be important for holistic care . This would also address concerns that the single disease‐centric approach of the UNAIDS 90‐90‐90 strategy may jeopardise funding for other much‐needed health programmes .…”

Section: Discussionmentioning

confidence: 99%

Using a HIV registry to develop accurate estimates for the HIV care cascade – the Singapore experience

Huang

Wong

et al. 2019

J Intern AIDS Soc

View full text Add to dashboard Cite

Introduction Achieving UNAIDS 90‐90‐90 targets is a crucial step towards ending the AIDS epidemic. Many countries have published estimates of care cascades, although often with methodological limitations. We describe an approach that used the national HIV registry as a starting‐point to determine the HIV care cascade and resulting UNAIDS 90‐90‐90 estimates for Singapore in 2014. Methods HIV is a legally notifiable disease in Singapore. The anonymized HIV registry data provided for a back‐calculation model from the European Centre for Disease Prevention and Control to obtain 2014 estimates for the total number of persons living with HIV (PLHIV), and the count in the registry for proportions diagnosed with HIV and linked to care. Using additional data collected for a simple random sample from the registry, outcomes in 2015 and 2016 were ascertained retrospectively to derive proportions for those retained in care, on antiretroviral therapy, and achieved viral suppression. Findings were extrapolated to derive national estimates and UN90‐90‐90 estimates. Bootstrapped samples from the model and sample were used to derive 95% confidence intervals. Results An estimated 6900 (95% CI 6650, 7050) persons were living with HIV and AIDS in 2014. Of these, 4948 were diagnosed with HIV, and 4820 had been linked to care. The random sample of 500 persons was further analysed, and of these, 87.2% were retained in care, 84.6% on antiretroviral therapy, and 79.6% had suppressed viral loads. The proportions of HIV‐infected individuals on antiretroviral therapy and achieving viral suppression were 60.7% (95% CI 58.4, 63.6) and 57.1% (95% CI 55.0, 60.5) respectively. The corresponding UNAIDS 90‐90‐90 estimates were 71.7% (95% CI 70.0, 74.2) of all persons diagnosed; 84.6% (95% CI 81.6, 87.4) of diagnosed persons being on antiretroviral therapy, and 94.1% (95% CI 91.6, 96.2) of persons on therapy having achieved viral suppression. Conclusions A national HIV registry, alongside back‐calculation and additional data from a sample, can be used to estimate attainment of UNAIDS 90‐90‐90 targets and identify system gaps. The registry had advantages of providing a well‐established, comprehensive capture of diagnosed persons and easily accessible data. The same approach can be used elsewhere if similar data are available.

show abstract

UNAIDS 90–90–90 targets to end the AIDS epidemic by 2020 are not realistic: comment on “Can the UNAIDS 90–90–90 target be achieved? A systematic analysis of national HIV treatment cascades”

Cited by 146 publications

References 12 publications

Impact of Therapeutic Education on the Viral Load of HIV Infected Children and Adolescents on Antiretroviral Therapy at the Douala Laquintinie Hospital, Cameroon

Impact of Therapeutic Education on the Viral Load of HIV Infected Children and Adolescents on Antiretroviral Therapy at the Douala Laquintinie Hospital, Cameroon

Population uptake and effectiveness of test‐and‐treat antiretroviral therapy guidelines for preventing the global spread of HIV: an ecological cross‐national analysis

Using a HIV registry to develop accurate estimates for the HIV care cascade – the Singapore experience

Contact Info

Product

Resources

About