Abstract
IntroductionUNAIDS “90-90-90” strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. Reaching these targets by 2020 will reduce the HIV epidemic to a low-level endemic disease by 2030. However, moving the global response towards this universal test and treat model will pose huge challenges to public health systems in resource-limited settings, including global and local supply chain systems. These challenges are especially acute in Africa, which accounts for over 70% of the persons affected by HIV.DiscussionFrom a supply chain perspective, each of the “90's” has possible complications and roadblocks towards realizing the promise envisioned by 90-90-90. For instance, ensuring that 90% of HIV-infected persons know their status will require a large increase in access to HIV tests compared with what is currently available. To ensure that there are enough anti-retrovirals available to treat the nearly 25 million people that will require them by 2020 represents a near doubling of the ARV supplied to treat the 13 million currently on treatment. Similarly, to monitor those on treatment means an unprecedented scale-up of viral load testing throughout Africa.ConclusionsLarger issues include whether the capacity exists at the local level to handle these commodities when they arrive in the most severely affected countries, including considerations of the human resources and costs needed to make this strategy effective. We believe that such “real world” analysis of proposed strategies and policies is essential to ensure their most effective implementation.
Highlights
UNAIDS ‘‘90-90-90’’ strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression
In 2014, UNAIDS announced bold new targets for the global response to HIV, aptly named the 90-90-90 strategy, that 90% of people living with HIV (PLHIV) know their status, 90% of diagnosed PLHIV are on treatment and 90% of PLHIV on treatment achieve an undetectable viral load, by 2020 [1]
Each ‘‘90’’ poses specific challenges due largely to already strained infrastructure, and opportunities for innovation, in sub-Saharan Africa which accounts for over 70% of persons living with HIV
Summary
In 2014, UNAIDS announced bold new targets for the global response to HIV, aptly named the 90-90-90 strategy, that 90% of people living with HIV (PLHIV) know their status, 90% of diagnosed PLHIV are on treatment and 90% of PLHIV on treatment achieve an undetectable viral load, by 2020 [1]. As regards the first 90, at most 50% of infected persons currently know their status, globally, despite few strains in the global supply chain for testing commodities, and many community actors keen to bring testing to their neighbours [2]. The second 90 poses the greatest challenge with estimates that, to support over 28 million on treatment in sub-Saharan Africa alone, means delivering 30 containers of medicines across Africa each day, every day (Iain Barton, personal communication). Lessons to tackle this huge logistical challenge in the most affected countries can be taken from commercial sector supply chains.
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