Sweden, the first country to achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90‐90‐90 continuum of HIV care targets

Abstract

ObjectivesThe Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90‐90‐90 goals propose that 90% of all people living with HIV should know their HIV status, 90% of those diagnosed should receive antiretroviral therapy (ART), and 90% of those should have durable viral suppression. We have estimated the continuum of HIV care for the entire HIV‐1‐infected population in Sweden.MethodsThe Swedish InfCare HIV Cohort Study collects viral loads, CD4 counts, and viral sequences, along with demographic and clinical data, through an electronic clinical decision support system. Almost 100% of those diagnosed with HIV infection are included in the database, corresponding to 6946 diagnosed subjects living with HIV‐1 in Sweden by 31 December 2015.ResultsUsing HIV surveillance data reported to the Public Health Agency of Sweden, it was estimated that 10% of all HIV‐infected subjects in Sweden remain undiagnosed. Among all diagnosed patients, 99.8% were linked to care and 97.1% of those remained in care. On 31 December 2015, 6605 of 6946 patients (95.1%) were on ART. A total of 6395 had been on treatment for at least 6 months and 6053 of those (94.7%) had a viral load < 50 HIV‐1 RNA copies/mL.ConclusionsThe 2014 UNAIDS/WHO 90‐90‐90 goals for HIV care means that > 73% of all patients living with HIV should be virologically suppressed by 2020. Sweden has already achieved this target, with 78% suppression, and is the first country reported to meet all the UNAIDS/WHO 90‐90‐90 goals.

Progress towards the United Nations 90‐90‐90 and 95‐95‐95 targets: the experience in British Columbia, Canada

“…In light of the global consensus on the UN targets , the findings of this study should help inform the continued scale‐up of TasP strategies in other contexts . In the United States, 86% of PLWH were diagnosed, but only 42% of them were on ART, and 82% of those who were on ART were virologically suppressed in 2011 [.]…”

“…In light of the global consensus on the UN targets [10], the findings of this study should help inform the continued scaleup of TasP strategies in other contexts [44][45][46][47][48][49][50]. In the United States, 86% of PLWH were diagnosed, but only 42% of them were on ART, and 82% of those who were on ART were virologically suppressed in 2011 [44.] The majority (70%) of the countries in Europe that reported data on the percentage of diagnosed PLWH on ART were under 70%.…”

European AIDS Clinical Society Second Standard of Care Meeting, Brussels 16‐17 November 2016: a summary

“…In Switzerland, linkage to care has been estimated to be around 98% . Comparable figures have been generated in Sweden, Denmark and the UK . Data from Belgium were slightly below these figures, with retention in care around 92% .…”

Preventing acquisition of HIV is the only path to an AIDS-free generation

“…One important reality check for the 90-90-90 program is the fragmented health care systems, inadequate human resources, and lack of sustainable funding for ART in almost all of the most affected countries with extensive HIV epidemics, making the goals outlined by the UNAIDS for 2020 mostly aspirational. Currently, only Sweden has achieved the UNAIDS three-part target of the 90-90-90 program (5). A recent study evaluating the treatment cascades of 69 countries showed that for target 1, The Netherlands had achieved 87% of the 90% target set, and for targets 2 and 3, Switzerland, at 71%, had the highest rate of people on treatment, but of these people, only 68% had achieved viral suppression (6), demonstrating the enormous difficulties in achieving these targets even in high-income countries.…”