Port of Spain, Trinidad and Tobago (TDN) — In a new move to jointly address the HIV epidemic and improve the lives of people living with the virus, countries in Latin America and the Caribbean and partner organisations have established new targets for expanding diagnosis and antiretroviral treatment (ART) and reducing patients’ viral loads by the year 2020.
The new targets–dubbed “90-90-90”–were adopted during the First Latin American and Caribbean Forum on the HIV Continuum of Care, which is being held this week in Mexico City. The Forum was organised by a coalition of partners including Mexico’s Secretariat of Health, the Joint United Nations Programme on HIV and ADS (UNAIDS) and the Pan American Health Organisation/World Health Organisation (PAHO/WHO).
“Expanding early diagnosis and treatment combines the clinical benefits of early treatment for patients with benefits to the population of preventing transmission,” said César Nuñez, Regional Director of UNAIDS for Latin America.
Massino Ghidinelli, chief of PAHO/WHO’s HIV, Hepatitis, Tuberculosis and Sexually Transmitted Infections Unit, said the new targets are a step forward in controlling the HIV/AIDS epidemic. “If we want more people to be on treatment and to achieve undetectable viral loads, they have to know their diagnosis and begin treatment early.”
In 2012, some 1.8 million people in Latin America and the Caribbean were living with HIV, and some 98,000 people became newly infected, according to UNAIDS estimates.
The new “90-90-90” targets
Target 1: Increase the proportion of people with HIV who know their diagnosis to 90%
New PAHO/WHO estimates for 2013 suggest that 70% of people living with HIV in Latin America and the Caribbean know they are infected. This is an average based on data from countries that account for 62% of the region’s HIV epidemic. However, in some countries fewer than half know their HIV diagnosis. Expanding testing—by increasing the availability of tests and involving communities and civil society in the effort—will lead to more people with HIV seeking the treatment they need.
Target 2: Increase the proportion of people receiving antiretroviral treatment to 90%
Some 725,000 people with HIV were receiving antiretroviral treatment in Latin America and the Caribbean as of December 2012, and preliminary PAHO/WHO estimates suggest this number increased to more than 800,000 by December 2013.
Treatment coverage rates in Latin America and the Caribbean are higher than in any other low- and middle-income region. However, WHO’s newest HIV guidelines recommend earlier initiation of treatment (when one’s CD4 cell count falls to 500 cells/mm³ or less), which has increased the number of people who meet the criteria for receiving treatment. Applying the new criteria to 2012 data would reduce the region’s coverage rate to 43%.
Expanding treatment would contribute to better health for people with HIV, reduce cases of AIDS and prevent new infections. Toward this end, countries agreed to revise their models of care to make treatment more accessible.
Target 3: Increase the proportion of people under treatment who have an undetectable viral load
PAHO/WHO data indicate that some 66% of people with HIV in Latin America and the Caribbean had suppressed viral loads in 2013. Reaching the 90% target will require improved patient adherence to treatment.
Suppressed viral load is critical for controlling the harmful effects of HIV infection on people’s health and also significantly reduces the risk of infecting others.
To promote adherence and keep patients under treatment, HIV health care must be decentralised to levels that allow greater interaction with the community.
Countries also agreed on a fourth target: reducing delayed diagnosis. As of 2013, half of countries providing data reported that at least a third of people with HIV were at an advanced stage of immunological disease at the time of their diagnosis. This situation has been improving, however, with late diagnoses declining from 40% to 35% between 2012 and 2013, reflecting expanded HIV testing in a number of countries.
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