Beyond viral suppression of HIV – the new quality of life frontier

Abstract

BackgroundIn 2016, the World Health Organization (WHO) adopted a new Global Health Sector Strategy on HIV for 2016–2021. It establishes 15 ambitious targets, including the ‘90-90-90’ target calling on health systems to reduce under-diagnosis of HIV, treat a greater number of those diagnosed, and ensure that those being treated achieve viral suppression.DiscussionThe WHO strategy calls for person-centered chronic care for people living with HIV (PLHIV), implicitly acknowledging that viral suppression is not the ultimate goal of treatment. However, it stops short of providing an explicit target for health-related quality of life. It thus fails to take into account the needs of PLHIV who have achieved viral suppression but still must contend with other intense challenges such as serious non-communicable diseases, depression, anxiety, financial stress, and experiences of or apprehension about HIV-related discrimination. We propose adding a ‘fourth 90’ to the testing and treatment target: ensure that 90 % of people with viral load suppression have good health-related quality of life. The new target would expand the continuum-of-services paradigm beyond the existing endpoint of viral suppression. Good health-related quality of life for PLHIV entails attention to two domains: comorbidities and self-perceived quality of life.ConclusionsHealth systems everywhere need to become more integrated and more people-centered to successfully meet the needs of virally suppressed PLHIV. By doing so, these systems can better meet the needs of all of their constituents – regardless of HIV status – in an era when many populations worldwide are living much longer with multiple comorbidities.

Is a Doctor Like a Toaster? Earning Trust in the Profession of Medicine

“…New scientific discoveries have prompted changes in clinical practices involving prevention, early identification and intervention, and surveillance. These changes have led to increased survival and enhanced quality of life in patients with infectious diseases [23]; cardiac disease [24]; lung, breast, colon, and prostate cancers [25]; diabetes [26]; and, also importantly, mental disorders [27,28]. Looking ahead, advancing efforts to improve health outcomes and transform quality and safety standards have emerged as a foremost commitment across the entire US health care system [29].…”

Living with HIV in regional Queensland: social ties, care and support in managing a long-term complex chronic illness

“…Grounded in Squire's argument, this thesis demonstrates through people's 1 A Map of Queensland is presented later in this chapter 2 35 years old or older considered 'older PLHIV' because most would have been infected in their teens or as young adults prior to 1996, the year in which HAART became available in Australia 3 Further defined in this chapter 4 Further discussed in this chapter and chapter two experiences that, indeed, a test and treat paradigm is insufficient. My work converses with the new directions for HIV care, which recognize the importance of health-related quality of life [11,12], beyond the test and treat model [13] 5…”

“…The global HIV prevention strategic plan set out in 2011 in the Political Declarations on HIV/AIDS (the UNDP), to achieve 90% infected people diagnosed, 90% on treatment and 90% virally suppressed (90-90-90) by year 2020 reflects that focus [13]. In 2016 the World Health Organization acknowledged that health-related quality of life was an important goal of ART treatment beyond ART adherence [11], indicating a possible shift from focusing solely on 90-90-90 to incorporating considerations around quality of life of positive people [12]. Lazarus and colleagues (2016) noted, however, that we need to understand what healthrelated quality of life for positive people entails and how to achieve it [12].…”

“…There are various biomedical, social and moral implications of introducing these new ways of using ART for HIV prevention [78,79]. How the information about TaSP and PrEP has impacted study participants has not been explored in my study 12 , however, introduction of these new biotechnologies present yet another element of the changing medical and policy environment around ART in which positive people live.…”

“…Within the UNDP global HIV prevention strategic plan (90-90-90) [13] there is a decreased focus on the wider social determinants and social supports necessary for people living with HIV for these goals to be met and for overall quality of life to be improved. While the new Global Health Sector Strategy on HIV for 2016-21 [11] acknowledges that viral suppression is not the ultimate goal of treatment and calls for person-centred care, it does not propose a specific target with which to measure progress beyond 90-90-90 [12] 25 .…”