This document discusses epidemic control in the context of HIV/AIDS. It defines epidemic control as reaching a point where new HIV infections fall below deaths from all causes in infected individuals. It outlines global 90-90-90 goals to achieve epidemic control by having 90% of infected people know their status, 90% on antiretroviral therapy, and 90% virally suppressed. While some countries like Zambia have met 90-90-90 targets, new global infections remain off target for epidemic control due to declining rates of status awareness, treatment coverage, and viral suppression in recent years.

1. What is Epidemic
Control?
After 2020
Dr Albert Mwango BScHB, MBChB, MPH
April 08, 2021
“Fast-tracking Towards HIV Epidemic Control While
Maintaining Quality Health Care”

2. presentation outline
•What is epidemic control
•definitions
•where are we now?
•where are we trying to get to?
2

3. epidemic control
• epidemic control is reached when the total number of new
HIV infections fall below the total number of deaths from all
causes among HIV-infected individuals
https://www.pepfar.gov/documents/organization/264884.pdf
3

4. Control? Elimination?
Eradication?
• Disease Control: in public health means reducing the
number of:
• new infections,
• people currently infected,
• people who become sick or die from a disease in a local
setting
• Regarding HIV/AIDS, this is achieved through deliberate
efforts of providing the care and resources necessary to
stop the virus from spreading from one person to another
Disease
Eradication
Disease
Elimination
Disease
control
EGPAF
4

5. Control? Elimination?
Eradication?
• Elimination: this means stopping
the transmission of a disease in a
specific geographic area or country
but not worldwide
• Pediatric HIV is an example of how, by using
control measures like PMTCT, the disease
among children can be eliminated in some
countries
Disease
Eradication
Disease
Elimination
Disease
control
EGPAF
5

6. Control? Elimination?
Eradication?
• Eradication: this is the permanent
reduction of a disease to zero
cases through deliberate measures
• Once a disease has been eradicated,
intervention measures are no longer needed
• Smallpox - only disease officially eradicated
(WHO 1980)
Disease
Eradication
Disease
Elimination
Disease
control
EGPAF
6
CDC

7. Global HIV 90-90-90 Goals
•This is the target set
to be achieved by
2020
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8. Epidemic Control and 90-90-90
Goals
8
•How are the 90-90-90 Goals related
to Epidemic Control??

9. Epidemic Control and 90-90-90
Goals
9
https://www.pepfar.gov/documents/organization/274400.pdf
Casing point: Swaziland

10. Epidemic Control and 90-90-90
Goals
Sharp decline
10
https://www.pepfar.gov/documents/organization/274400.pdf
Casing point: Swaziland
Starts with decline of
new infections

11. Epidemic Control and 90-90-90
Goals
Sharp decline
What will trigger the
decline?
11
https://www.pepfar.gov/documents/organization/274400.pdf
Casing point: Swaziland
Starts with decline of
new infections

12. Epidemic Control and 90-90-90
Goals
Sharp decline
12
https://www.pepfar.gov/documents/organization/274400.pdf
Modeled estimates
show that new HIV
infections would
dramatically decline if
73 percent of all
people living with HIV
are virally suppressed
73%
PLVS

13. Epidemic Control and 90-90-90
Goals
• How do we get to this
ultimate Epidemic Control
target of
73
%?
HIV +, 100
Know Status, 90
Are on ART, 81
Viral Suppressed, 72.9
0
10
20
30
40
50
60
70
80
90
100
HIV EC Modeling
HIV + Know Status Are on ART Viral Suppressed
100% 90% 90% 90%
13

14. Epidemic Control and 90-90-90
Goals
• How do we get to this
ultimate Epidemic Control
target of
73
%?
HIV +, 100
Know Status, 90
Are on ART, 81
Viral Suppressed, 72.9
0
10
20
30
40
50
60
70
80
90
100
HIV EC Modeling
HIV + Know Status Are on ART Viral Suppressed
100% 90% 90% 90%
14
(90% x 90% x 90%)

15. So where should we be?
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16. Epidemic Control and 90-90-90
Goals
Epidemic Control Target (R0):
73% of all PLHIV
Virally Suppressed
By 2020
16
https://www.pepfar.gov/documents/organization/274400.pdf

17. Global 90-90-90 (2016)
17
ENDING AIDS PROGRESS TOWARDS THE 90-90-90 (Global AIDS Report 2017)
Joint United Nations Programme on HIV/AIDS (UNAIDS)
(70% x 77% x 82%) =

18. Global 90-90-90 (2016)
% towards
Epidemic Control
44.2% 18
ENDING AIDS PROGRESS TOWARDS THE 90-90-90 (Global AIDS Report 2017)
Joint United Nations Programme on HIV/AIDS (UNAIDS)
(70% x 77% x 82%) =

19. Global 90-90-90 (2019)
% towards
Epidemic Control
32.0% 19
90-90-90: Treatment for all (2020)
Joint United Nations Programme on HIV/AIDS (UNAIDS)
Poor
response
WHY?

20. Globally: Reductions in new infections are off
target 2016
NEW HIV INFECTIONS, ALL AGES, GLOBAL 1990-
2016 AND 2020 TARGET
20
“Fast-tracking Towards HIV Epidemic Control While
Maintaining Quality Health Care”

21. Globally: Reductions in new infections are off
target 2020
NEW HIV INFECTIONS, ALL AGES, GLOBAL 1990-
2018 AND 2020 TARGET
21
Globally Epidemic
Control is not being
achieved due to
derailed reduction of
new infections

22. Global Negative factors
• Proportion of people who know their status and on ART
has dropped in the last 2 years
• Proportion of people on ART and are virally suppressed
has dropped in last 2 years
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23. Road to Epidemic Control -
Zambia
1993, 120,000
2003, 74,000
2016, 59,000
2019, 51,000
2003, 70,000
2016, 21,000
2019, 17,000
0
20,000
40,000
60,000
80,000
100,000
120,000
19911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019
New HIV Infections and AIDS Deaths (all ages, all populations)
New HIV infections (all ages) AIDS-related deaths (all ages)
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http://www.cidrz.org/2020/12/02/zambia-attains-909090-unaids-hiv-aids-epidemic-control-targets/
https://www.unaids.org/en/regionscountries/countries/zambia

24. Zambia -Point of reflection
•What factors are hindering triggering in
epidemic control?
•Uncontrolled concentrated epidemic?
•Socio economic underlying barriers?
•Compromised quality of care?
•Data issues?
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25. Conclusion
• Globally the number of HIV infections has not reduced
as targeted, and so EC is off target
• To achieve epidemic control in Zambia, we must sustain
or improve on the 90-90-90 targets and this will
eventually trigger the sharp decline, however this has
not been seen
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26. ...