With a focus on both scaled up goals and limited funding, PEPFAR released its Technical Considerations for COP/ROP 2016 this week, outlining strategies necessary to provide access to testing and effective treatment to more people immediately, while maintaining efforts to confront tuberculosis and deliver other essential prevention and health services.
Changes to the document reflect support on the part of the world’s largest response to a single disease for World Health Organization guidelines recommending all people diagnosed with HIV have immediate access to antiretroviral treatment, and for UNAIDS 90-90-90 goals that call for at least 90 percent of people living with HIV to be diagnosed, at least 90 percent of them to have access to treatment, and for treatment to be effective and consistent enough among at least 90 percent of those receiving it to suppress their viruses to undetectable levels. At the same time the document observes that “While viral suppression of 73 percent of [people living with HIV] is the ultimate target for the 90-90-90 goals,* it is important to note that this is only achievable if people living with HIV are alive, on [antiretroviral treatment] and virally suppressed. If [people living with HIV] become ill and die of TB, the question of being virally supressed becomes irrelevant.” The document emphasizes needs to scale up tuberculosis screening, diagnosis and prevention efforts as well as the role of activities to tackle the diseases together in reaching PEPFAR goals.
Noting that “a significant gap remains between the clear scientific evidence of what works and the comprehensive implementation of these evidence-based interventions, it addresses “priority” and “key” populations, the document urges country teams to use incidence data where available, as well as prevalence data. But it also notes the importance of civil society input to successful efforts, pointing to Country Operational Plans for 2015 delineating steps to include civil society, and reminding country teams that “community involvement cannot be an afterthought . . .”
The full document is available here.
*(You do the math: 90 percent of 90 percent of 90 percent)