Abstract
UNAIDS 90‐90‐90 targets and Fast‐Track commitments are presented as precursors to ending the AIDS epidemic by 2030, through effecting a 90% reduction in new HIV infections and AIDS‐related deaths from 2010 levels (HIV epidemic control). Botswana, a low to middle‐income country with the third‐highest HIV prevalence, and Australia, a low‐prevalence high‐income country with an epidemic concentrated among men who have sex with men (MSM), have made significant strides towards achieving the UNAIDS 90‐90‐90 targets. These two countries provide lessons for different epidemic settings. This paper discusses the lessons that can be drawn from Botswana and Australia with respect to their success in HIV testing, treatment, viral suppression and other HIV prevention strategies for HIV epidemic control. Botswana and Australia are on target to achieving the 90‐90‐90 targets for HIV epidemic control, made possible by comprehensive HIV testing and treatment programmes in the two countries. As of 2015, 70% of all people assumed to be living with HIV had viral suppression in Botswana and Australia. However, HIV incidence remains above one per cent in the general population in Botswana and in MSM in Australia. The two countries have demonstrated that rapid HIV testing that is accessible and targeted at key and vulnerable populations is required in order to continue identifying new HIV infections. All citizens living with HIV in both countries are eligible for antiretroviral therapy (ART) and viral load monitoring through government‐funded programmes. Notwithstanding their success in reducing HIV transmission to date, programmes in both countries must continue to be supported at current levels to maintain epidemic suppression. Scaled HIV testing, linkage to care, universal ART, monitoring patients on treatment over and above strengthened HIV prevention strategies (e.g. male circumcision and pre‐exposure prophylaxis) will all continue to require funding. The progress that Botswana and Australia have made towards meeting the 90‐90‐90 targets is commendable. However, in order to reduce HIV incidence significantly towards 2030, there is a need for sustained HIV testing, linkage to care and high treatment coverage. Botswana and Australia provide useful lessons for developing countries with generalized epidemics and high‐income countries with concentrated epidemics.
Highlights
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the 90-90-90 targets to be reached by 2020 in order to end the AIDS epidemic by 2030 [1], and subsequently expanded them in the Fast-Track commitments drawn from the 2016 United Nations Political Declaration [2]
The 90-90-90 HIV care cascade targets are that by 2020, 90% of people living with HIV (PLHIV) will be diagnosed, 90% of those diagnosed will be on antiretroviral therapy (ART), and 90% of people on treatment will achieve viral suppression
Prevention strategies captured in the Fast-Track approach include eliminating new infections among children, improving access to combination HIV prevention options including condom programming, pre-exposure prophylaxis (PrEP), and voluntary medical male circumcision (VMMC) in priority countries; eliminating gender inequalities and violence; focusing on young people, and HIV-sensitive social protection; shifting towards community-based service delivery; investing in HIV prevention and social enablers; addressing human rights issues for PLHIV and those at risk; and improving universal health coverage, including treatment for tuberculosis, cervical cancer and hepatitis B and C [2]
Summary
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the 90-90-90 targets to be reached by 2020 in order to end the AIDS epidemic by 2030 [1], and subsequently expanded them in the Fast-Track commitments drawn from the 2016 United Nations Political Declaration [2]. The 90-90-90 HIV care cascade targets are that by 2020, 90% of people living with HIV (PLHIV) will be diagnosed, 90% of those diagnosed will be on antiretroviral therapy (ART), and 90% of people on treatment will achieve viral suppression. Should the two countries achieve the desired 90% reduction in new HIV infections and end AIDSrelated deaths by 2030, valuable lessons can be learned. This commentary compares the HIV epidemics in these countries, their progress towards achieving the 90-90-90 targets alongside HIV incidence, and identifies lessons for HIV epidemic control in similar settings
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