The 90-90-90 target aims to help end the AIDS epidemic by 2020 by having 90% of people living with HIV know their status, 90% of those diagnosed on treatment, and 90% of those on treatment virally suppressed. The target was established by UNAIDS and WHO to drive progress beyond 2015 by setting clear goals. Achieving the target would require increased testing, treatment, and viral load monitoring services especially in sub-Saharan Africa where most people living with HIV lack treatment. Barriers like stigma, remote locations, and costs must also be addressed to achieve the 90-90-90 goals by 2020.

1. 90-90-90
An Ambitious treatment target to
help end the AIDS epidemic
Nancy Somi

2. What's 90-90-90?
A new HIV treatment narrative that lays the ground works to end the AIDS epidemic
• By 2020, 90% of all people living with HIV will know their HIV status.
• By 2020, 90% of all people with diagnosed HIV infection will receive sustained
antiretroviral therapy
• By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
The target was initiated by UNAIDS under WHO.

4. Why the 90-90-90 Target
• Target will drive progress. Until December 2013 more than 60% of people
living with HIV lacked HIV treatment underscoring the need for intensified
efforts to bring HIV treatment to all those who need it
• Target guides action taken beyond 2015-Ending AIDS will require new
milestones to guide and accelerate progress in the post 2015 era
• Target promotes accountability-A clearly articulated goal enables diverse
stakeholders to identify respective roles and responsibilities.
• A bold Target undescores that ending AIDS epidemic is achievable-
Boldly grasping this challenge ensures that ending AIDS epidemic in the
world is possible by 2030.

5. How will 90-90-90 succeed
• Focus on the new quality and outcomes of antiretroviral therapy as
treatment services are scaled up.
• The new target captures both the therapeutic and preventive benefits of
HIV treatment.
• It prioritizes equity- Unless all communities affected by HIV have full and
equitable access to life saving treatment and other prevention services the
world will not end the AIDS epidemic.

6. First 90:90% diagnosed
• African countries are either approaching or within the striking distance of
having at least 90% of people living with HIV/AIDS tested at least.
• Until December 2013 only 45% of people living with HIV knew their status
in sub-Saharan Africa.
• The gap underscores a need for more frequent testing.
• Testing in multi disease health campaigns in Kenya and Uganda increased the
testing coverage to 86% and 72%.

7. Second 90:90% on HIV treatment.
• High treatment coverage is also achieved in some settings e.g. in Botswana
and Colombia more than 70% of people diagnosed with HIV are now
receiving antiretroviral therapy.
• Recomending antiretroviral therapy to all people with HIV infection without
requiring prior CD4 count will enhance treatment and reduce loss to follow
up.
• Countries will need to implement issues that slow up implemtation like;
pharmacy stock outs, procurement of medicnes and second and third line
regimens.

8. Last 90:90%Viral Suppressed
• High levels of viral suppression have been achieved in some countries e.g 17
countries in Latin America and Carribean countries have 66% of those
diagnosed are viral suppressed.
• Viral suppression doesn’t count for AIDS related mortality or loss to follow
up highlighting efforts to retain those who are loss to follow among the ones
enrolled in care.
• Viral load testing will lower treatment costs and help clinicians identify early
treatment failure.

9. Last 90 contd…..
• Ensuring universal access to viral load testing in all settings is vital.
• UNAIDS,WHO, ASLM and US CDC jointly convened the role of
laboratory medicine in meeting the 90-90-90 targets in June 2014
• The meeting was aimed at building robust, sustainability laboratory capacity
that will be needed to meet the global treatment goals

11. Challenges along the road!
• Societal Challenges- Stigma, discrimination
• Delivery Challenges-Centralization of treatment centers reduces success of
treatment. Strategies should be tailored by stakeholders to make sure even
those in remote areas can access HIV treatment.
• Costs of achieving the 90-90-90 target-Increased funding will be needed to
end the AIDS epidemic.Costs are incured in drugs,delivery service,laboratory
capacity and community mobilization to ensure testing and retention in care.