The UNAIDS 90-90-90 targets aim to substantially decrease HIV transmission but it is unknown whether they can be achieved at scale in generalised epidemics. We report data from HPTN 071 (PopART), the largest programme to deliver universal testing and treatment at population level in Southern Africa, to determine how close we are to reaching the targets after two years of intervention.
The intervention comprises annual rounds of home-based HIV counselling and testing delivered by Community HIV Care Providers (CHiPs) who also support linkage to care, retention on ART and other HIV-related services. CHiP data from four communities in Zambia receiving the full PopART intervention (including universal ART irrespective of CD4 count), were used to determine proportions of adults who knew their HIV-positive (HIV+) status before and after the second annual round (R2: Jun 2015 – Sep 2016), and the proportions of known HIV+ adults who were on ART. Extrapolating from these data, we estimated overall proportions of HIV+ adults in these communities who knew their HIV+ status (first-90) and the proportion of these who were on ART (second-90) before and after R2.
By the end of August 2016, 45,616 households had been visited by CHiPs for the second annual round; 110,755 adult residents of these households (aged 18+) were enumerated, of whom 84,186 (76%) were contacted and consented to the intervention. Based on data from these participants, estimated total numbers of HIV+ adults in these four communities were 6,216 men and 10,341 women (Table), of whom 78% of men and 90% of women (86% overall) knew their HIV+ status following the R2 annual visit (first-90). Among these known HIV+ adults, 80% of men and 80% of women were estimated to be on ART by the end of R2 (second-90). For both targets, coverage was higher in those who had participated during R1 than in those who had not. Comparison of R1 and R2 estimates shows a continuing increase in coverage particularly for the second-90.
After two rounds of intervention, 86% of HIV+ adults were estimated to know their HIV+ status, close to the first-90. Of those known HIV+, an estimated 80% were on ART, approaching the second-90. Continuing efforts are needed to speed up linkage to care and ART initiation in order to reach the second-90. Lower coverage in the large number of clients who had not participated during R1 emphasises the need for annual re-visits in urban communities with high rates of mobility and migration.