Image: Burnet Institute Econometrician Dr Nick Scott
Burnet Institute research has shown that meeting or even exceeding the UNAIDS 90-90-90 targets in Australia will not be enough to achieve the national and international goal of a 90-percent reduction in HIV incidence by 2030.
The research, published in the journal Clinical Infectious Diseases, demonstrates that a considerable scale-up in testing and stronger focus on prevention will be required to reduce HIV incidence to levels that approach this type of reduction and help ‘end AIDS’.
The aim for the 90-90-90 targets is to have 90 percent of people living with HIV knowing their status, 90 percent of these people diagnosed on treatments, and 90 percent of people on treatments with suppressed viral loads by 2020.
These targets have been promoted as a mechanism to reduce HIV incidence by 90 percent from 2010 levels by 2030.
The Burnet study led by Dr Nick Scott found that even if the UNAIDS targets were recalibrated to 95-95-95 in Australia, HIV incidence would be reduced by only 10-20 percent, in part because Australia already has high levels of diagnosis, engagement with care and treatment coverage.
“So we asked what would be needed to achieve the 90 percent reduction in HIV incidence and looked at a range of interventions including increases in testing frequency, and increases in PrEP coverage and condom use among men who have sex with men,” Dr Scott said.
“Our modelling showed that with very high coverage of all of these things, we can come close to achieving the 90 percent reduction target, so we really need to prioritise prevention while continuing to maintain our diagnosis and retention in care.
“We’re doing very well with our UNAIDS targets around diagnosis and treatment, but the separate target of reducing incidence by 90 percent is a significant challenge and it’s not going to happen without focused efforts to improve prevention and increase testing frequency.”
Dr Scott said modelling and analytic tools have proven to be extremely useful in helping to inform the development of policies to guide the type and level of effort required to successfully ‘end AIDS’ as a public health threat by 2030.
Burnet Institute is contributing to these efforts by developing simplified diagnostic tests, working with the community on peer-led testing strategies and the development of strategies for home-based testing, working with The Alfred hospital on the roll out of PrEP, and the development of an HIV vaccine.
“An HIV vaccine is something that Burnet is working hard to achieve and, if it can be done, it’s going to be very important, especially over the 2030 time frame,” Dr Scott said.
Find out more about Burnet’s disease elimination research.