Fast-Track Cities progress toward UNAIDS’ 90-90-90 goal

NEW ORLEANS — Cities throughout the world have been making progress toward treatment targets set for 2020, but officials must not become complacent, an HIV/AIDS specialist said at ASM Microbe.

Benjamin Young, MD, PhD, senior vice president and chief medical officer of the International Association of Providers of AIDS Care (IAPAC), presented data from the Fast-Track Cities Initiative, an effort to expedite HIV care linkage globally.

Benjamin Young

The initiative includes more than 70 cities with high HIV burdens around the world whose leaders and community members have agreed to work to achieve the UNAIDS 90-90-90 goal, which aims to have 90% of people living with HIV (PLHIV) diagnosed, 90% of those diagnosed on ART, and 90% of those on ART achieve viral suppression, all by 2020.

The Fast-Track Cities also seek to eliminate discrimination against PLHIV and the stigma often attached to the infection, which Young said are daunting challenges to linking patients to treatment.

“The 90-90-90 slogan isn’t just a slogan,” Young said during his presentation. “It’s about accelerating testing and care and accelerating treatment responses ... and doing so in urban settings because those urban settings are the incubators for public health and [disease] prevention.”

Young said the initiative is focused on cities also because PLHIV are largely concentrated in urban areas (60%). They include Kingston, where 64% of Jamaica’s PLHIV reside.

In all, the initiative targets 200 cities for aid in stepping up HIV diagnosis and care through cooperation between the agencies leading the effort and local authorities and community members. Although results so far are diverse, progress is being made, Young said.

According to IAPAC data, the percentages of PLHIV meeting the three measures of diagnosis, treatment and viral suppression as of 2015 in Amsterdam, the Netherlands, were 94%, 90% and 94%, respectively. In Kiev, Ukraine, the percentages were 51%, 44% and 85%, respectively. Victoria State, Australia, achieved 90%, 94% and 93%.

In Paris, where the initiative was signed by the 26 original participating cities in 2014, the percentages that same year were 81%, 82% and 94%. In São Paulo, Brazil, the percentages were 82%, 59% and 78% in 2014.

Miami-Dade County, Florida, had 88% of its PLHIV diagnosed in 2015 but had no data for the other two goals. That year, Denver achieved 90% for diagnosis and viral suppression but had no data for those on ART. The figures in New York City, where about 87,600 PLHIV live, were 94%, 82% and 74%.

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Several sub-Saharan African countries are also showing progress, Young said. That was evident in a door-to-door survey of more than 100,000 homes in Zimbabwe, Malawi and Zambia in 2015 and 2016, Young said.

That study included children and adults. But in his presentation, Young focused on data for patients between the ages 15 and 59 years. Of those, the respective 90-90-90 goal percentages were 72.6%, 86.5% and 86.2% in Zimbabwe. In Malawi, the figures were 72.3%, 89.5% and 91.1%. In Zambia, they were 66%, 85% and 89.4%.

Sweden is the only country that, as a whole, has met all the UNAIDS 90-90-90 goal thus far, but Young said “others in the European Union are close behind.”

He also urged his audience not to be discouraged.

“Ending epidemic AIDS is entirely possible,” Young said. “But it requires our commitment, our collective global dedication and the imagination that the plague of our generation can end.” – by Joe Green

References:

Justman JE, et al. Abstract 114LB. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 13-16, 2017; Seattle.

Young B. Fast-Track Cities: Toward UNAIDS 90-90-90 goals. Presented at: ASM Microbe; June 1-5, 2017; New Orleans.

Disclosure: Young reports working as a consultant and on advisory boards for Gilead Sciences, Merck and ViiV Healthcare. He reports serving on the speakers’ bureau for Merck and receiving research support from Gilead Sciences, Merck and ViiV Healthcare.