IAS 2017: With midpoint numbers showing 90-90-90 goals near for some, eluding others, innovation and equalizers take precedence

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Science Speaks is in Paris this week covering the 9th IAS Conference on HIV Science.

PARIS – With a graph showing an apparently achievable trajectory from the 19.5 million people on treatment at the end of 2016, to the 30 million people who must receive treatment by 2020 to control HIV as a global health threat within the 10 years that then follow, a preconference session here examining progress toward UNAIDS testing and treatment goals had to take some time to bask in optimism.

Seven countries, numbers released two days earlier showed, have already reached the goals — of 90 percent of people with the virus knowing it, 90 percent of those on treatment, and treatment consistent and effective enough to suppress the virus in 90 percent of them. Averaged out across the world, the midpoint numbers from UNAIDS showing 70 percent of people with the virus diagnosed, 77 percent of them on treatment, and 82 percent of them with suppressed viruses, showed, presenters said, that a goal once considered out of reach could be attained.

But the 10.5 million yet to access treatment, the countries where numbers continue to show more people undiagnosed, and untreated than not, and where new infections continue to climb, show also, as Dr. Diane Havlir of the East Africa SEARCH trial put it, “that yesterday’s approach is going to fall short of today’s aspirations.”

Havlir was one of a series of presenters across two days before this conference began examining needs and means of new ways to reach more, treat more, and, in the process create lasting responsive health systems.

Their themes, of innovations that included strengthened and expanded reliance on community-based care, on access to better, more effective and less toxic treatment regimens, and of approaches tailored to reach those marginalized by the laws and policies of their own countries, set the stage for a conference that will focus on new ways to deliver health services and in the process change public health approaches around the world. They include extending the reach of self-testing, of same day treatment initiation, and the reach of providers. In the process, they will aim to knock down obstacles between care and children, older people, men, women, gay and bisexual people, people who earn income through sex work, transgender people, people with chronic diseases, and the hundreds of thousands of people living with HIV who go without preventive treatment, adequate diagnosis, and effective treatment for tuberculosis each year.

Dr. Wafaa El-Sadr of ICAP

The approaches needed to fill the gaps currently facing all of those, Dr. Wafaa El-Sadr said, taking the theme forward in an opening session today, will share the aims of “efficiency, equity, and epidemic control.”

Her talk provided a preview of the days — and years — ahead, characterized by client-centered care, and, as she put it “putting people living with HIV at the center” of work to end the grip of the virus on their lives.

It is a focus that promises, at the least, a refreshing week.

“What got us here,” Dr. El-Sadr said, “won’t get us there.”

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