Guide gives direction to the last 90

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Sharon Weir

The following is a guest post By Sharon Weir, Ph.D. of MEASURE Evaluation

For almost 35 years, HIV/AIDS has been a household word across the globe. At first a death sentence, HIV has infected 78 million people, killing almost half of them as the world battled it into submission as a treatable, chronic—but still dangerous—condition.

It is easy to say that the first step in a journey is the hardest, but for people living with HIV, the most important clinical step is reaching the place where the diagnosis has been made, treatment has been successful, and HIV is finally no longer detectable. In other words, the last step.

Imagine what this last step would mean for someone on treatment. It is great news and offers hope for a normal lifespan and reassurance that they will not transmit the virus to someone else—something not thinkable only a few years ago. I’ve spent years of my career working in this arena and have a real sense of the progress made. Unfortunately, however, not everyone receiving HIV treatment has an up-to-date viral load test. Sometimes the tests are too expensive or not available for everyone on treatment, or there are problems conducting the test or communicating the results.

Besides being a problem for the individual patient, not knowing how many people on treatment achieve viral suppression is a problem for public health programs across the globe. We aspire to be in the last stages of combatting the epidemic—to end AIDS as a public health threat by 2030, only a dozen years from now, and achieving the last “90” of the HIV cascade* is crucial. Sabrina Zadrozny and Jess Edwards have led the development of a tool—just published by MEASURE Evaluation, funded by the United States Agency for International Development and the U.S. President’s Plan for AIDS Relief —to help public health programs assess biases in the testing data so we can better estimate how many people treated have achieved viral suppression.

It is no substitute for collecting test results from everyone but, for now, this tool provides a strategy to address a major information gap. The new guidance is for use in resource-limited settings and the approaches can be used for any population living with HIV or can be tailored to focus on subgroups. The new resource includes a Viral Load Calculator, which uses well-established, evidence-based methods in a new way to estimate viral suppression from routine HIV care and treatment data.

The Viral Load Calculator can help provide important program-level data to inform epidemic control efforts while scale-up of routine testing is in progress. For programs where routine viral load monitoring already is a reality, the Viral Load Calculator can quantify the success of the monitoring or identify challenges with distribution of antiretroviral therapy, adherence, and retention in HIV care and treatment. The Viral Load Calculator can also be used to identify disparities in the quality of care if disaggregated by gender, age, location, and behavioral risk factors.

Getting to the last 90? Now more possible than ever with this very recent guideline.

Access the Applying New Methods to Estimate Viral Suppression: The “Last 90” guidelines.

For more information on MEASURE Evaluation, please visit www.measureevaluation.org

  • “90-90-90” refers to the global goal that, by 2020, 90 percent of those who are HIV-positive will have been diagnosed, 90 percent of those diagnosed will be on antiretroviral therapy (ART), and 90 percent of those on ART will be virally suppressed (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2017).

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