In October of 2014, UNAIDS released 90-90-90 –An Ambitious Treatment Target to Help End the AIDS Epidemic, which outlined a three-pronged global strategy to help end the worldwide AIDS epidemic by 2030.

The 90-90-90 treatment targets:

1. By 2020, 90% of all people living with HIV (PLWH) will know their HIV status.

2. By 2020, 90% of all people with diagnosed HIV infection (PLWDHI) will receive sustained antiretroviral therapy.

3. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

 

 

As New York State embarks on its initiative to end the epidemic in NY by 2020, we have prepared a blog post to view our progress locally through the lens of the 90-90-90 plan.

How close is New York to reaching the UNAIDS global goals?

1. By 2020, 90% of all people living with HIV will know their HIV status.fig 2

In 2013, out of an estimated 129,000 persons infected with HIV and residing in New York, approximately 112,000 have a confirmed diagnosis (87%).

New York State is well underway to reaching or even exceeding this goal by 2020.  HIV testing initiatives such as NYC Department of Health’s Bronx Knows and Brooklyn Knows (launched in 2008 and 2010 respectively) have contributed to this success. In December of 2014, New York Knows was launched and expanded the testing initiative to cover all five NYC boroughs.

 

 

 

 

2. By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.

Since NYS does not collect population-based data on sustained uptake of antiretroviral therapy (ART), it is not possible to generate a direct estimate for comparison with the 90% target.  However, since only 86,000 (77%) of PLWDHI showed evidence of receiving care in 20131 and not all of them are receiving ART, it is clear that NYS has a long way to go in order to reach the 90-90-90 goal of 90% of all PLWDHI receiving sustained ART.

Despite widespread availability of ART medications in NYS and around the United States, some PLWH may be uninsured or underinsured and have difficulty accessing these essential medicines.  Programs like the national AIDS Drug Assistance Program (ADAP) have played an important role in providing prescription drugs to low-income persons living with HIV who have little to no access to prescription drugs.2

3. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

In 2013, 63% of all persons living with diagnosed HIV (PLWDHI) in NYS were virally suppressed (Figure below), while 82% of those with evidence of care were virally suppressed.  

Despite the increased proportion of those in care who are suppressed, there are noted regional, race/ethnicity and risk group differences in viral load suppression rates across NYS (Figure below).  Closing this gap of PLWH who are not virally suppressed is a pre-requisite to ending the epidemic in NYS.

vls nys

 

While the 90-90-90 targets emphasize HIV infected persons knowing their status and receiving antiretroviral therapy, an important limitation is that they ignore the importance of timing in both of these stages of HIV care.  At the population level, there is evidence that reducing late HIV diagnosis accompanied with timely ART initiation can substantially reduce morbidity, mortality, and onward HIV transmission.

For information on median CD4 count at diagnosis in NYS (an indicator of timeliness of HIV diagnosis following infection) read more here.

 

  1. Cases with any HIV care (reported VL or CD4 test) during the year, (NYSDOH/BHAE 2013).
  2. AIDS Drug Assistance Programs (ADAPs). April 8, 2014.