The 90-90-90 goals and Fast Track Cities - A success story?

Taslima Rashid

Specialist Registrar in HIV and Sexual Health

Chelsea and Westminster Healthcare NHS Fdn Trust, London, UK

Disclosures

Honoraria from ViiV

Content

• UNAIDs / Fast Track Cities

• London data / European data

• Are the targets a success?

90-90-90 Targets

2014

- Life saving treatment

- Transmission prevention measure

- A human right

Source: (UNAIDS 2015). On the Fast-Track to end AIDS. UNAIDS 2016-2021 Strategy.

FAST TRACK TARGETS / UNAIDS TARGETS

Fast-track Cities

Source Fast-track Cities website: People living with HIV - 2015

Countries achieving the 90-90-90 target

London / UK data 2017 dataAREA 1st 90% 2nd 90% 3rd 90%

LONDON 2017 (38, 600 PLWHIV)

95% 98% 97%

UK 2017 92% 98% 97%

Source: PHE Progress towards ending the HIV epidemic in the UK 2018 report PHE publications gateway number: 2018607

UK MSM 2015 2017

3,390 2,330

UK MSM 2012 2017

2,700 1,200

UK Heterosexual 2008 2017

Black African 2,424 542

Black Caribbean 231 52

White 429 (2016) 296

Estimated annual new infections

Incidence

LONDON HIV CARE CONTINUUM DATA

Routine HIV testing

Source: Chelsea and Westminster Hospital website 2011

TEST AND TREAT

COMBINATION HIV PREVENTION

MSM

IDU

HETERO

MSM

IDU

HETERO

MSM

IDUHETERO47% born

abroad

Distribution of new HIV diagnoses in 2017,by sub-region

10% born abroad

1% born abroad

Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data

Availability of ART for undocumented migrants 2018

Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

Source: Alvarez del-Arco, et al. High levels of post-migration HIV acquisition within nine European countries. AIDS, 2017.

Global issues

- Criminalisation of sexual preference

- Criminalisation of drug use

- Criminalisation of sex work

- Criminalisation of HIV

MSM

DRUG OFFENCES

SEX WORKERS

CRIMINALISATION OF HIV

What can we do to improve?1. Expanded access to testing in routine settings

such as family physician clinics, emergency departments, outpatient clinics

2. Better and more standardised reporting of treatment cascades

3. Improvement of partner notification strategies 4. Making key patient populations central to

outreach and healthcare innovations and strategies

Conclusions

▪ 90-90-90 targets are fantastic, but often clouds the real issues

▪ Late diagnosis of HIV is still very common – testing coverage low

▪ Repeat testing is key and HIV prevention should be prioritised

ON

TR

EATM

ENT

VIR

AL

SU

PP

RES

SIO

N

DIA

GN

OSE

D

PLH

IV

TESTING

LINKAGE TO CARE

RETENTION & ADHERENCE

SUPPORT

QUALITY OF LIFE

PREVENTION(PrEP, condoms, NSP, OST)

Priorities for action:

Source: Teymur Noori, European CDC talk HIV Clinical Topics, Barcelona 2019