Ingrid Hein

October 11, 2016

The 90-90-90 targets for HIV will dominate discussion at the upcoming Controlling the HIV Epidemic with Antiretrovirals Summit 2016 in Geneva.

"When we launched this series of summits several years ago, we did not have consensus on the importance of scaling up treatment as prevention and pre-exposure prophylaxis," said José Zuniga, PhD, president of the International Association of Providers of AIDS Care.

"We spent a lot of time building that consensus and moving stakeholders to support this intervention, which ultimately is the foundation for obtaining the 90-90-90 targets," he told Medscape Medical News.

The targets set by the United Nations (UN) General Assembly are designed to end the AIDS epidemic by 2030. The initiative sets out three targets; by 2020, 90% of people with HIV infection will be diagnosed, 90% of people diagnosed will be on antiretroviral therapy, and the virus will be suppressed in 90% of people receiving antiretroviral therapy.

In his keynote address, Michel Sidibé, executive director of UN AIDS, will discuss the strategies, emerging opportunities, and political processes involved in meeting the 90-90-90 targets. Antiretroviral suppression and pre-exposure prophylaxis (PrEP) will play a major role in the achievement of these goals.

"One of the big topics we are going to address is where we stand with PrEP," said Dr Zuniga. "PrEP used to prevent the transmission of HIV, often taken by partners of people living with HIV, hasn't been approved in many countries, and uptake is slow in countries where it has been approved, including the United States."

However, in the United Kingdom, the National Health Services has gone to court to try to force the government to pay for PrEP, he reported.

In addition, "there will be discussion on stigma, discrimination, leaving no one behind as we try to advance PrEP, and the way treatment-as-prevention agendas will move forward," Dr Zuniga said.

In many places, prevention and HIV therapies are still difficult to obtain. For example, countries like Nigeria have taken an anti-LGBT stance, which poses a challenge and a threat, not only to treatment delivery, but also to agencies providing financial and medical support. "Those challenges will come up throughout the meeting," he pointed out.

New WHO Recommendations to Emerge

An update of the 2008 WHO guidelines will be launched at the meeting. The focus is now on public health "task shifting" to support the 90-90-90 goals, such as "shifting care from physicians to nurses and from nurses to community health workers," Dr Zuniga said.

"We will also discuss recommendations for new models of care." These will include better ways to implement the test-and-treat strategy — offering antiretrovirals immediately after diagnosis — and treatment as prevention — using antiretrovirals to reduce the viral load to an undetectable level to decrease, or even eliminate, the risk for HIV transmission.

Sessions on treatment as prevention will address the challenges of maintaining the current momentum and look at ways to scale up antiretroviral therapy, including delivery models.

A panel discussion dedicated to differentiated care will examine issues such as whether patients really need to be seen every 3 months, or whether 6-month intervals would be a workable option. "We are looking for efficiencies," Dr Zuniga explained. "We recognize the current model of care is too expensive and needlessly onerous for patients and the health system."

Quality-of-life issues will also be discussed. "There are now whole communities of survivors living longer and living with comorbidities that were previously unimagined but are now commonplace. We need to address these," he said.

Beyond Science: Economic Discussion With International Leaders

Panelists discussing discrimination and sustainable development goals related to the 90-90-90 targets will include Ambassador Deborah Birx, MD, global AIDS coordinator, special representative for global health diplomacy, and head of the President's Emergency Plan for AIDS Relief (PEPFAR); Lucica Ditiu, MD, from the Stop TB Partnership in Geneva; and Mark Dybul, MD, executive director of the Global Fund.

Frank discussion about economic challenges and shifts in leadership will be of special interest this year, Dr Zuniga pointed out. The United States is the biggest financial contributor to the fight against HIV/AIDS, so "obviously, the US election will loom large."

The outcome of the election will likely have an effect on that fight, said Jeffrey Sachs, PhD, director of the Earth Institute, an organization at Columbia University in New York City that addresses issues facing the planet and its inhabitants.

"If Trump wins, we're just going to be in a state of confusion on public policy for quite a while. If Clinton wins, it's still going to be necessary to break the status quo of the financial envelope and the organizational envelope," he explained. "So one way is likely to be a disaster for the world for many reasons, and the other is still going to be a big challenge."

"We need to be organized no matter what," he added.

"I look forward to meeting with the international leadership," said Dr Sachs, whose presentation at the meeting will be on why AIDS should be a world priority.

He said he hopes to come out of the meeting with a clearer roadmap to success by focusing on advocacy and strategy in the right direction.

"For me, that's a major goal — to understand the current realities and right strategic approaches," he said. "There's nothing about this issue that can be taken with complacency. When we're mobilizing the necessary resources, every day matters, and politics is always hard on that."

Dr Zuniga and Dr Sachs have disclosed no relevant financial relationships.


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