Evaluating the Use of 90-90-90 for HIV Policy in the Asian Context

Main Article Content

Richard M. Grimes
Deanna E. Grimes

Abstract

UNAIDS recommends the 90-90-90 policy for controlling HIV infection (identify 90% of HIV cases, provide care for 90% of these, and have 90% of the treated achieve viral suppression). 90-90-90 requires an accurate measurement of HIV prevalence, which is impossible to achieve. Prevalence must be estimated. Customarily, 90-90-90 prevalence estimates are based on point estimates at the midpoint of a credible range of high and low estimates. This paper examines the effect of the high and low estimates on 90-90-90. We examined the impact on policy goal based on 90% of the point estimate, if the true prevalence were the credible range’s high or low estimate. This was calculated for 14 Asian Countries (Afghanistan, Cambodia, Indonesia, Iran, Kazakhstan, Laos Malaysia, Myanmar, Nepal, Pakistan, Philippines Thailand, Uzbekistan, Viet Nam) that UNAIDS estimated point prevalence of prevalence greater than 10,000 persons. If the low estimate for the 14 countries was the true prevalence, 11 of the countries could not achieve 90% of the point estimate because the low prevalence was less than 90% of the point estimate. The other three countries, would have to identify 97.5% to 99.0% of infected persons to achieve 90% of the point prevalence. If the true prevalence is the high estimate, twelve of the countries would have identified only 76.8% to 84.9 of the true prevalence. Afghanistan (26.0%) and Iran (40.8%) would have identified far fewer persons than the point estimate goal. Therefore 90-90-90 should be considered to be non-evaluable and should not be used for policy making.

Keywords:
90-90-90, HIV prevalence, evaluation, Asia, policy

Article Details

How to Cite
Grimes, R. M., & Grimes, D. E. (2021). Evaluating the Use of 90-90-90 for HIV Policy in the Asian Context. Asian Journal of Medicine and Health, 19(3), 43-48. https://doi.org/10.9734/ajmah/2021/v19i330312
Section
Policy Article

References

UNAIDS. 90-90-90. An ambitious treatment target to help end the AIDS epidemic. Available:http://www.unaids.org/en/resources/909090. Accessed Nov 30, 2020.

Cohen MS, Chen YQ, McCauley M. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493-505.

Gourlay A, Noori T, Pharris A, Axelsson M, Costagliola D, Cowan S, et al. The human immunodeficiency virus continuum of care in European Union countries in 2013: Data and challenges. Clin Infect Dis. 2017;64: 1644-56.

Porter K, Gourlay A, Attawell K, et al. Substantial Heterogeneity in progress toward reaching the 90-90-90 HIV target in the WHO European Region. J Acquir Immune Defic Syndr. 2018;79:28–37.

Levi J, Raymond A, Pozniak A, Vernazza P, Kohler P, Hill A. Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades. BMJ Global Health. 2016;1: e000010. DOI: 10.1136/bmjgh-2015-000010

Marsha K, Eaton JW, Mahya M, Sabina K, Autenrietha CS, Wanyekia I, et al. Global, regional and country-level 90–90–90 estimates for 2018: Assessing progress towards the 2020 target. AIDS. 2019; 33(Suppl 3):S213–S226.

Grimes RM, Grimes DE. Medication costs associated with early initiation of antiretroviral therapy. AIDS Care. 2018; 30(12):1512-15.

Dutta A, Barker C, Kallarakal A. The HIV Treatment Gap: Estimates of the Financial Resources Needed versus Available for Scale-Up of Antiretroviral Therapy in 97 Countries from 2015 to 2020. PLoS Med. 12(11): e1001907.

Bain LE, Nkoke C, Noubiap JJN. 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”. BMJ Global Health 2017;2:e000227. DOI: 10.1136/bmjgh-2016-000227.

Jamieson D, Kellerman SE. The 90 90 90 strategy to end the HIV Pandemic by 2030: Can the supply chain handle it? J Int AIDS Soc. 2016;19(1):20917.

Dave S, Peter T, Fogarty C, Karatzas N, Belinsky N, Pai NP. Which community based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence. (2007-2018). PLoS One. 14(7): e0219826. Available:https://doi.org/10.1371/journal.pone.0219826

Mbuagbaw L, Hajizadeh A, Wang A, Mertz D, Lawson DO, Smieja M, et al. Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: Part 1. BMJ Open. 2020;10:e034793. DOI: 10.1136/bmjopen-2019-034793

Fast Track Cities. About fast track Cities. Available:https://www.fast-trackcities.org/abou Accessed Oct 23, 2020.

UNAIDS. Annex on Methods. Available:http://aidsinfo.unaids.org/documents/estimates_methods_2018.pdf Accessed November 30, 2020

Rohr JK, Manne-Goehler J, Gómez-Olivé FX, Wagner RG, Rosenberg M, Geldsetzer P et al. HIV treatment cascade for older adults in rural South Africa. Sex Transm Infect. 2020;96(4):271–276.

UNAIDS HIV data and estimates. UNAIDS. DATA; 2020. Available:https://www.unaids.org/en/resources/documents/2020/unaids-data Accessed November 30, 2020.