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Botswana close to reaching the 90-90-90 testing and treatment targets
Keith Alcorn, 2016-02-25 02:20:00

Botswana is already close to reaching the 90-90-90 target for testing, treatment and viral suppression, and is ahead of the United States and most European countries in its efforts to improve treatment coverage, Tendani Gaolathe of the Botswana-Harvard AIDS Institute Partnership reported at CROI 2016 in Boston on Wednesday.

Furthermore it has achieved this level of coverage when providing treatment to people with CD4 cell counts below 350 cells/mm3, even before moving to provide treatment for everyone diagnosed with HIV infection.

An analysis of treatment coverage in a large population-based study of antiretroviral treatment as prevention – the PopART study – also found that substantial increases in treatment coverage had been achieved as a result of a comprehensive package of home-based HIV testing and linkage to care in Kwazulu Natal, South Africa, and in Zambia.

The 90-90-90 target set by UNAIDS encourages countries to aim to achieve:

  • Diagnosis of 90% of people living with HIV by 2020

  • Initiation of treatment by 90% of diagnosed people by 2020

  • Viral suppression in 90% of people on treatment by 2020

This sequence of actions, or `treatment cascade` would result in viral suppression in 73% of all people living with HIV by 2020, enough to greatly reduce HIV transmission and gradually reduce HIV prevalence.

Previous international reviews of treatment cascade performance have shown that northern European countries and Australia have made the greatest progress towards reaching the 90-90-90 target. The most recent review, presented at the Eighth International AIDS Society Conference last year in Vancouver, found that Switzerland, Australia, the United Kingdom, Denmark and the Netherlands are well on their way to achieving this target; in each case, easily attainable improvements in the rate of diagnosis or treatment initiation should allow these countries to reach the goal.

That study found that 32% of people with HIV in sub-Saharan Africa were virally suppressed, compared with 30% in the United States.