The 90-90-90 goals and Fast Track Cities - A success...
Transcript of The 90-90-90 goals and Fast Track Cities - A success...
The 90-90-90 goals and Fast Track Cities - A success story?
Taslima Rashid
Specialist Registrar in HIV and Sexual Health
Chelsea and Westminster Healthcare NHS Fdn Trust, London, UK
Disclosures
Honoraria from ViiV
Content
• UNAIDs / Fast Track Cities
• London data / European data
• Are the targets a success?
90-90-90 Targets
2014
- Life saving treatment
- Transmission prevention measure
- A human right
Source: (UNAIDS 2015). On the Fast-Track to end AIDS. UNAIDS 2016-2021 Strategy.
FAST TRACK TARGETS / UNAIDS TARGETS
Fast-track Cities
Source Fast-track Cities website: People living with HIV - 2015
Countries achieving the 90-90-90 target
London / UK data 2017 dataAREA 1st 90% 2nd 90% 3rd 90%
LONDON 2017 (38, 600 PLWHIV)
95% 98% 97%
UK 2017 92% 98% 97%
Source: PHE Progress towards ending the HIV epidemic in the UK 2018 report PHE publications gateway number: 2018607
UK MSM 2015 2017
3,390 2,330
UK MSM 2012 2017
2,700 1,200
UK Heterosexual 2008 2017
Black African 2,424 542
Black Caribbean 231 52
White 429 (2016) 296
Estimated annual new infections
Incidence
LONDON HIV CARE CONTINUUM DATA
Routine HIV testing
Source: Chelsea and Westminster Hospital website 2011
TEST AND TREAT
COMBINATION HIV PREVENTION
MSM
IDU
HETERO
MSM
IDU
HETERO
MSM
IDUHETERO47% born
abroad
Distribution of new HIV diagnoses in 2017,by sub-region
10% born abroad
1% born abroad
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
Availability of ART for undocumented migrants 2018
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
Source: Alvarez del-Arco, et al. High levels of post-migration HIV acquisition within nine European countries. AIDS, 2017.
Global issues
- Criminalisation of sexual preference
- Criminalisation of drug use
- Criminalisation of sex work
- Criminalisation of HIV
MSM
DRUG OFFENCES
SEX WORKERS
CRIMINALISATION OF HIV
What can we do to improve?1. Expanded access to testing in routine settings
such as family physician clinics, emergency departments, outpatient clinics
2. Better and more standardised reporting of treatment cascades
3. Improvement of partner notification strategies 4. Making key patient populations central to
outreach and healthcare innovations and strategies
Conclusions
▪ 90-90-90 targets are fantastic, but often clouds the real issues
▪ Late diagnosis of HIV is still very common – testing coverage low
▪ Repeat testing is key and HIV prevention should be prioritised
ON
TR
EATM
ENT
VIR
AL
SU
PP
RES
SIO
N
DIA
GN
OSE
D
PLH
IV
TESTING
LINKAGE TO CARE
RETENTION & ADHERENCE
SUPPORT
QUALITY OF LIFE
PREVENTION(PrEP, condoms, NSP, OST)
Priorities for action:
Source: Teymur Noori, European CDC talk HIV Clinical Topics, Barcelona 2019