Efforts to control the HIV epidemic in Zimbabwe, Malawi and Zambia have made excellent progress. A considerable survey endeavor has found that the three hard-hit nations are approaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) so-called 90-90-90 targets.
UNAIDS has called upon nations to get 90 percent of their HIV populations diagnosed, 90 percent of that group on antiretroviral (ARV) treatment and 90 percent of that group to full viral suppression, meaning that 73 percent of the overall HIV population would have a fully suppressed virus.
Achieving these targets by 2020 would be instrumental in eliminating HIV as a public health threat by 2030, particularly considering the increasing body of research suggesting that those with full viral suppression may be virtually incapable of transmitting the virus and that their risk of transmission may in fact be zero.
Findings from the survey efforts were presented at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.
Researchers in the Population-based HIV Impact Assessment Project (PHIA) conducted surveys among nationally representative samples of a cumulative 76,000 adults and 34,000 children in Zimbabwe, Malawi and Zambia. The participants were approached at home and interviewed. At this time, they also provided blood samples for HIV testing (results were returned during the same visit); viral load tests were given to those participants who tested positive.
The combined proportion of the nations’ populations living with HIV was 12.2 percent among 15- to 59-year-olds and 1.4 percent among children 14 years old and younger. The yearly proportion of the combined adult populations estimated to contract the virus each year was 0.51 percent. The combined proportion of those living with HIV who had a viral load below 1,000, meaning they were considered virally suppressed, was 62 percent.
Among the HIV population of these three nations combined, 70 percent were diagnosed, 87 percent of those diagnosed had been given ARVs and 89 percent of those on ARVs were virally suppressed. These figures were higher for older adults compared with younger ones. The progress reflected in these figures has been less pronounced among adolescents and young adults compared with older adults.
Although the research revealed that great strides have been made toward tackling the HIV epidemic, investigators stressed that targeted testing of the virus is needed to increase the diagnosis rate and that HIV treatment and other prevention programs must be expanded to help push the nations to the 90-90-90 goal.
“These results are gratifying evidence that the investment by PEPFAR and other donors, and the efforts of national HIV programs, are paying off,” Shannon Hader, MD, MPH, director of the division of global HIV and tuberculosis at the Centers for Disease Control and Prevention (CDC), said in a press release, referring to the U.S. President’s Emergency Plan For AIDS Relief, a George W. Bush era international aid program that is a cornerstone of HIV treatment access in sub-Saharan Africa. “The data from the PHIA surveys provide greater insights on where to focus our collective efforts and resources going forward.”