Reaching UNAIDS 90-90-90 goals, of 90 percent of people living with HIV diagnosed, 90 percent of those diagnosed accessing antiretroviral therapy, and treatment in at least 90 percent of those individuals suppressing their virus to undetectable levels would not only benefit populations and improve individual health but would be cost-efficient a study has found.
The study, published in the Annals of Internal Medicine, used an HIV treatment and progression model to compare outcome data from the current HIV strategy used in South Africa to the UNAIDS target strategy. Researchers found:
- Currently, 24 percent of South Africans living with HIV have viral suppression. Under the current pace of the HIV response in South Africa, 44 percent will have achieve viral suppression after ten years. Under the UNAIDS target strategy, South Africa would achieve 74 percent viral suppression after five years, and 80 percent suppression after 10 years.
- Under the current pace, 2.6 million South Africans will achieve viral suppression while nearly 3 million will go undiagnosed and unlinked to care. Under the UNAIDS target strategy, over 5 million will achieve viral suppression and 870,000 will have undiagnosed disease.
- With the current pace, South Africa will see 450,000 new infections every year, resulting in 4.4 million new infections over 10 years. Under the UNAIDS strategy, the number of new infections would be halved and 2 million infections would be averted over the ten year period.
- The number of deaths would also be halved under the UNAIDS strategy, with 2.5 million deaths over 10 years instead of the nearly 5 million deaths over ten years under the current strategy.
- Currently there are an estimated 900,000 children in South Africa who have lost a mother to HIV. Under the current pace, that number rises to nearly 3 million after ten years. Under the UNAIDS strategy, that number would be reduced to 1.2 million maternal orphans after ten years.
The current strategy will cost $38.35 billion over ten years, while the UNAIDS strategy would cost more than half again as much — about $54.3 billion over ten years, according to the study. While acknowledging the UNAIDS strategy would require a 14 percent annual increase in budget over a 10 year period, study authors note the results add up to savings, and recommend that policymakers mobilize political and economic support to implement the strategy.
“Achieving the UNAIDS target strategy could have a transformative impact,” authors write, “averting millions of new HIV infections, saving millions of lives and tens of millions of years of life, and preventing millions of children from becoming orphans.”
“Based on our findings, there is nothing overstated about the suggestion that 90-90-90 could lay the foundation for a healthier, more just and equitable world for future generations,” study lead author Dr. Rochelle P. Walensky said in a statement from Massachusetts General Hospital.
Walensky presented the findings this week in New York.