90-90-90An Ambitious treatment target to help end the

AIDS epidemic

Nancy Somi

What's 90-90-90?

A new HIV treatment narrative that lays the ground works to end the AIDS epidemic

• By 2020, 90% of all people living with HIV will know their HIV status.• By 2020, 90% of all people with diagnosed HIV infection will receive sustained

antiretroviral therapy• By 2020, 90% of all people receiving antiretroviral therapy will have viral

suppression.

The target was initiated by UNAIDS under WHO.

Why the 90-90-90 Target

• Target will drive progress. Until December 2013 more than 60% of people living with HIV lacked HIV treatment underscoring the need for intensified efforts to bring HIV treatment to all those who need it

• Target guides action taken beyond 2015-Ending AIDS will require new milestones to guide and accelerate progress in the post 2015 era

• Target promotes accountability-A clearly articulated goal enables diverse stakeholders to identify respective roles and responsibilities.

• A bold Target undescores that ending AIDS epidemic is achievable-Boldly grasping this challenge ensures that ending AIDS epidemic in the world is possible by 2030.

How will 90-90-90 succeed

• Focus on the new quality and outcomes of antiretroviral therapy as treatment services are scaled up.

• The new target captures both the therapeutic and preventive benefits of HIV treatment.

• It prioritizes equity- Unless all communities affected by HIV have full and equitable access to life saving treatment and other prevention services the world will not end the AIDS epidemic.

First 90:90% diagnosed

• African countries are either approaching or within the striking distance of having at least 90% of people living with HIV/AIDS tested at least.

• Until December 2013 only 45% of people living with HIV knew their status in sub-Saharan Africa.

• The gap underscores a need for more frequent testing.• Testing in multi disease health campaigns in Kenya and

Uganda increased the testing coverage to 86% and 72%.

Second 90:90% on HIV treatment.

• High treatment coverage is also achieved in some settings e.g. in Botswana and Colombia more than 70% of people diagnosed with HIV are now receiving antiretroviral therapy.

• Recomending antiretroviral therapy to all people with HIV infection without requiring prior CD4 count will enhance treatment and reduce loss to follow up.

• Countries will need to implement issues that slow up implemtation like; pharmacy stock outs, procurement of medicnes and second and third line regimens.

Last 90:90%Viral Suppressed

• High levels of viral suppression have been achieved in some countries e.g 17 countries in Latin America and Carribean countries have 66% of those diagnosed are viral suppressed.

• Viral suppression doesn’t count for AIDS related mortality or loss to follow up highlighting efforts to retain those who are loss to follow among the ones enrolled in care.

• Viral load testing will lower treatment costs and help clinicians identify early treatment failure.

Last 90 contd…..

• Ensuring universal access to viral load testing in all settings is vital.

• UNAIDS,WHO, ASLM and US CDC jointly convened the role of laboratory medicine in meeting the 90-90-90 targets in June 2014

• The meeting was aimed at building robust, sustainability laboratory capacity that will be needed to meet the global treatment goals

Challenges along the road!• Societal Challenges- Stigma, discrimination• Delivery Challenges-Centralization of treatment centers reduces

success of treatment. Strategies should be tailored by stakeholders to make sure even those in remote areas can access HIV treatment.

• Costs of achieving the 90-90-90 target-Increased funding will be needed to end the AIDS epidemic.Costs are incured in drugs,delivery service,laboratory capacity and community mobilization to ensure testing and retention in care.