Achieving 90-90-90 Human Immunodeficiency Virus (HIV) Targets Will Not Be Enough to Achieve the HIV Incidence Reduction Target in Australia

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Abstract

Background. We estimated the human immunodeficiency virus (HIV) incidence reduction in Australia that would correspond to achieving the United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2020 and extended targets of 95-95-95 by 2030. This was done in combination with various scale-ups of HIV testing, primary prevention, and preexposure prophylaxis (PrEP) among high-risk men who have sex with men (MSM). These projections were evaluated against the target of achieving a 90% reduction in HIV incidence by 2030 compared with 2010 levels. Methods. A mathematical model. Results. Achieving 90-90-90 by 2020 was estimated to reduce incidence by 10% from 2010 levels. Achieving 95-95-95 by 2030 was estimated to reduce incidence by 17% from 2010 levels, with the first 95 being achievable by testing low-and high-risk MSM 2 and 4 times per year, respectively. This was improved to a 34% reduction by including a 5-year scale-up of PrEP to 30% coverage among high-risk MSM and to 45% by also increasing MSM condom use from 42% to 60%. However, even with 95-95-95, 2 and 4 tests per year for low-and high-risk MSM, 100% high-risk MSM PrEP coverage, and 100% MSM condom use, only an 80% reduction in incidence was possible by 2030. Conclusions. Many countries, particularly those with low HIV prevalence, will struggle to achieve a 90% reduction in HIV incidence by 2030, even if UNAIDS targets are met. Most will require substantially higher levels of prevention coverage and higher testing frequencies to reach this target.

Original languageEnglish
Pages (from-to)1019-1026
Number of pages8
JournalClinical Infectious Diseases
Volume66
Issue number7
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • Elimination targets
  • HIV
  • Mathematical model
  • Men who have sex with men
  • PrEP

Cite this

@article{d7f4b795361a40098944ebc85dcc047b,
title = "Achieving 90-90-90 Human Immunodeficiency Virus (HIV) Targets Will Not Be Enough to Achieve the HIV Incidence Reduction Target in Australia",
abstract = "Background. We estimated the human immunodeficiency virus (HIV) incidence reduction in Australia that would correspond to achieving the United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2020 and extended targets of 95-95-95 by 2030. This was done in combination with various scale-ups of HIV testing, primary prevention, and preexposure prophylaxis (PrEP) among high-risk men who have sex with men (MSM). These projections were evaluated against the target of achieving a 90{\%} reduction in HIV incidence by 2030 compared with 2010 levels. Methods. A mathematical model. Results. Achieving 90-90-90 by 2020 was estimated to reduce incidence by 10{\%} from 2010 levels. Achieving 95-95-95 by 2030 was estimated to reduce incidence by 17{\%} from 2010 levels, with the first 95 being achievable by testing low-and high-risk MSM 2 and 4 times per year, respectively. This was improved to a 34{\%} reduction by including a 5-year scale-up of PrEP to 30{\%} coverage among high-risk MSM and to 45{\%} by also increasing MSM condom use from 42{\%} to 60{\%}. However, even with 95-95-95, 2 and 4 tests per year for low-and high-risk MSM, 100{\%} high-risk MSM PrEP coverage, and 100{\%} MSM condom use, only an 80{\%} reduction in incidence was possible by 2030. Conclusions. Many countries, particularly those with low HIV prevalence, will struggle to achieve a 90{\%} reduction in HIV incidence by 2030, even if UNAIDS targets are met. Most will require substantially higher levels of prevention coverage and higher testing frequencies to reach this target.",
keywords = "Elimination targets, HIV, Mathematical model, Men who have sex with men, PrEP",
author = "Nick Scott and Mark Stoov{\'e} and Kelly, {Sherrie L.} and Wilson, {David P.} and Hellard, {Margaret E.}",
year = "2018",
month = "4",
day = "1",
doi = "10.1093/cid/cix939",
language = "English",
volume = "66",
pages = "1019--1026",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
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T1 - Achieving 90-90-90 Human Immunodeficiency Virus (HIV) Targets Will Not Be Enough to Achieve the HIV Incidence Reduction Target in Australia

AU - Scott, Nick

AU - Stoové, Mark

AU - Kelly, Sherrie L.

AU - Wilson, David P.

AU - Hellard, Margaret E.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background. We estimated the human immunodeficiency virus (HIV) incidence reduction in Australia that would correspond to achieving the United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2020 and extended targets of 95-95-95 by 2030. This was done in combination with various scale-ups of HIV testing, primary prevention, and preexposure prophylaxis (PrEP) among high-risk men who have sex with men (MSM). These projections were evaluated against the target of achieving a 90% reduction in HIV incidence by 2030 compared with 2010 levels. Methods. A mathematical model. Results. Achieving 90-90-90 by 2020 was estimated to reduce incidence by 10% from 2010 levels. Achieving 95-95-95 by 2030 was estimated to reduce incidence by 17% from 2010 levels, with the first 95 being achievable by testing low-and high-risk MSM 2 and 4 times per year, respectively. This was improved to a 34% reduction by including a 5-year scale-up of PrEP to 30% coverage among high-risk MSM and to 45% by also increasing MSM condom use from 42% to 60%. However, even with 95-95-95, 2 and 4 tests per year for low-and high-risk MSM, 100% high-risk MSM PrEP coverage, and 100% MSM condom use, only an 80% reduction in incidence was possible by 2030. Conclusions. Many countries, particularly those with low HIV prevalence, will struggle to achieve a 90% reduction in HIV incidence by 2030, even if UNAIDS targets are met. Most will require substantially higher levels of prevention coverage and higher testing frequencies to reach this target.

AB - Background. We estimated the human immunodeficiency virus (HIV) incidence reduction in Australia that would correspond to achieving the United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2020 and extended targets of 95-95-95 by 2030. This was done in combination with various scale-ups of HIV testing, primary prevention, and preexposure prophylaxis (PrEP) among high-risk men who have sex with men (MSM). These projections were evaluated against the target of achieving a 90% reduction in HIV incidence by 2030 compared with 2010 levels. Methods. A mathematical model. Results. Achieving 90-90-90 by 2020 was estimated to reduce incidence by 10% from 2010 levels. Achieving 95-95-95 by 2030 was estimated to reduce incidence by 17% from 2010 levels, with the first 95 being achievable by testing low-and high-risk MSM 2 and 4 times per year, respectively. This was improved to a 34% reduction by including a 5-year scale-up of PrEP to 30% coverage among high-risk MSM and to 45% by also increasing MSM condom use from 42% to 60%. However, even with 95-95-95, 2 and 4 tests per year for low-and high-risk MSM, 100% high-risk MSM PrEP coverage, and 100% MSM condom use, only an 80% reduction in incidence was possible by 2030. Conclusions. Many countries, particularly those with low HIV prevalence, will struggle to achieve a 90% reduction in HIV incidence by 2030, even if UNAIDS targets are met. Most will require substantially higher levels of prevention coverage and higher testing frequencies to reach this target.

KW - Elimination targets

KW - HIV

KW - Mathematical model

KW - Men who have sex with men

KW - PrEP

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U2 - 10.1093/cid/cix939

DO - 10.1093/cid/cix939

M3 - Article

VL - 66

SP - 1019

EP - 1026

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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