Roundup: AIDS 2016 focuses on ways to achieve 90-90-90 objectives

The 21st International AIDS Conference (AIDS 2016) entered its third day on Wednesday, with a focus on ways to achieve the 90-90-90 objectives.

The UNAIDS fast track strategy seeks to ensure that 90 percent of HIV-positive people know their status, 90 percent are able to access antiretroviral treatment (ART), and 90 percent of those on treatment attain viral suppression, by the year 2020.

Studies on treatment expansion in several Southern and East African countries presented at AIDS 2016 provide new insights on how to achieve the 90-90-90 objectives, while also identifying some critical obstacles to overcome.

Researchers in developing countries with high burdens of HIV infection are developing new strategies to advance towards global HIV treatment targets, participants at the conference heard.

Anton Pozniak, Clinical Service Director of the HIV Unit at the Chelsea and Westminster Hospital in London and Treasurer of the International AIDS Society, highlighted the scope of the task.

Pozniak referred to statistics from the UNAIDS Prevention Gap Report, which estimate that 57 percent of people living with HIV know their status currently, 46 percent of all people living with HIV have access to ART, and only 38 percent of people living with HIV have achieved viral suppression.

"The limited success of efforts to provide broader access to treatment are reflected in unacceptable mortality rates and a decreasing momentum in the reduction of new HIV infections globally," commented Pozniak.

"The research reported here offers valuable insight into the opportunities and the challenges we face in gearing up delivery systems to meet our HIV treatment goals," said Pozniak.

Two studies presented here focus on the impact of the "test and treat" approach to ARV therapy on expanding treatment access and improving retention in care. Under the test and treat model, the administration of ARVs begins as soon as possible after individuals learn they are HIV-positive, without regard to CD4 counts.

"Interim results from the SEARCH study, conducted in 164 communities in rural Kenya and Uganda, showed a significant advance toward achieving the UNAIDS 90-90-90 target among adults living with HIV," said Maya L. Petersen, Associate Professor of Biostatistics and Epidemiology, Berkeley School of Public Health in the United States.

"The study employed a community-based multi-disease approach to HIV testing combined with a patient-centred 'test and treat' model of ART. At the start of SEARCH, 45 percent of the HIV-positive population had viral loads below 500 copies/ml. Two years later, following the study intervention, 81 percent were virally suppressed," said Petersen.

In contrast, a study in 22 rural South African communities found little difference in viral suppression between those offered therapy through the test and treat approach, and those provided with standard ART according to national guidelines. Nine of 10 patients in both groups achieved viral suppression.

But the study identified a weakness in the middle of the 90-90-90 cascade - only one in three individuals newly diagnosed as HIV-positive was linked to treatment clinics within six months of testing. Endit