Achieving 90-90-90 HIV targets will not be enough to achieve the HIV incidence reduction target in Australia

Abstract

Background

We estimated the HIV incidence reduction in Australia corresponding to achieving the UNAIDS 90-90-90 targets by 2020 and extended targets of 95-95-95 by 2030, in combination with various scale-ups of HIV testing, primary prevention and pre-exposure prophylaxis (PrEP) among high-risk men who have sex with men (MSM). These projections were evaluated against the target of achieving a 90% reduction in HIV incidence by 2030 compared with 2010 levels.

Methods

A mathematical model was used to project annual HIV incidence for combinations of HIV care cascade targets, testing frequencies, primary prevention coverages and levels of PrEP scale-up.

Results

Achieving 90-90-90 by 2020 was estimated to reduce incidence by 10% from 2010 levels. Achieving 95-95-95 by 2030 was estimated to reduce incidence by 17% from 2010 levels, with the first 95 being achievable by testing low-/high-risk MSM two/four times per year respectively. This was improved to a 34% reduction by including a five-year scale-up of PrEP to 30% coverage among high-risk MSM; and to 45% by also increasing MSM condom use from 42% to 60%. However, even with 95-95-95, two/four tests per year for low-/high-risk MSM, 100% high-risk MSM PrEP coverage and 100% MSM condom use, only an 80% reduction in incidence was possible by 2030.

Conclusion

Many countries, particularly those with low HIV prevalence, will struggle to achieve a 90% reduction in HIV incidence by 2030 even if UNAIDS targets are met. Most will require substantially higher levels of prevention coverage and higher testing frequencies to reach this target.