Epidemic control status presentation at the National HIV Technical Conference, Lusaka Zambia, December 2017

1. What is HIV Epidemic
Control
Dr Albert Mwango BScHB, MBChB, MPH
Deputy CHIEF OF PARTY –Technical
CRS EpiC390
“Fast-tracking Towards HIV Epidemic Control While
Maintaining Quality Health Care”
December 2017

2. presentation outline
•what is epidemic control
•summary of data
•where are we now?
•where are we trying to get to?
2

3. epidemic control
• epidemic control is reached when the total number of new HIV
infections fall below the total number of deaths from all causes
among HIV-infected individuals
https://www.pepfar.gov/documents/organization/264884.pdf
3

4. Control? Elimination? Eradication?
• Disease Control: in public health
means reducing the number of:
• new infections,
• people currently infected,
• people who become sick or die from a
disease in a local setting
• Regarding HIV/AIDS, this is achieved
through deliberate efforts of providing
the care and resources necessary to
stop the virus from spreading from one
person to another
Disease
Eradication
Disease
Elimination
Disease
control
EGPAF
4

5. Control? Elimination? Eradication?
•Elimination: this means stopping
the transmission of a disease in
a specific geographic area or
country but not worldwide
• Pediatric HIV is an example of how, by
using control measures like PMTCT, the
disease among children can be
eliminated in some countries Disease
Eradication
Disease
Elimination
Disease
control
EGPAF
5

6. Control? Elimination? Eradication?
•Eradication: this is the
permanent reduction of a
disease to zero cases through
deliberate measures
• Once a disease has been eradicated,
intervention measures are no longer
needed
• Smallpox - only disease officially
eradicated (WHO 1980)
Disease
Eradication
Disease
Elimination
Disease
control
EGPAF
6
CDC

7. Global HIV 90-90-90 Goals
•This is the target set to
be achieved by 2020
7

8. Epidemic Control and 90-90-90 Goals
8
•How are the 90-90-90 Goals related to
Epidemic Control??

9. Epidemic Control and 90-90-90 Goals
9
https://www.pepfar.gov/documents/organization/274400.pdf
Casing point: Swaziland

10. Epidemic Control and 90-90-90 Goals
Sharp decline
10
https://www.pepfar.gov/documents/organization/274400.pdf
Casing point: Swaziland
Starts with decline of
new infections

11. Epidemic Control and 90-90-90 Goals
Sharp decline
What will trigger the
decline?
11
https://www.pepfar.gov/documents/organization/274400.pdf
Casing point: Swaziland
Starts with decline of
new infections

12. Epidemic Control and 90-90-90 Goals
Sharp decline
12
https://www.pepfar.gov/documents/organization/274400.pdf
Modeled estimates
show that new HIV
infections would
dramatically decline if
73 percent of all
people living with HIV
are virally suppressed
>73%
PLVS

13. Epidemic Control and 90-90-90 Goals
• How do we get to this ultimate
Epidemic Control target of
73%?
HIV +, 100
Know Status, 90
Are on ART, 81
Viral Suppressed, 72.9
0
10
20
30
40
50
60
70
80
90
100
HIV EC Modeling
HIV + Know Status Are on ART Viral Suppressed
100% 90% 90% 90%
13

14. Epidemic Control and 90-90-90 Goals
• How do we get to this ultimate
Epidemic Control target of
73%?
HIV +, 100
Know Status, 90
Are on ART, 81
Viral Suppressed, 72.9
0
10
20
30
40
50
60
70
80
90
100
HIV EC Modeling
HIV + Know Status Are on ART Viral Suppressed
100% 90% 90% 90%
14
(90% x 90% x 90%)

15. Why is viral suppression key?
•People living with HIV on
ART with an
undetectable viral load in
their blood have a
negligible risk of sexual
transmission of HIV
• HIV/AIDS disease
progression is very, very
slow in people living with
HIV on ART with an
undetectable viral load in
their blood
15

16. So where should we be?
16

17. Epidemic Control and 90-90-90 Goals
Epidemic Control Target (R0):
73% of all PLHIV
Virally Suppressed
By 2020
17
https://www.pepfar.gov/documents/organization/274400.pdf

18. So where are we?
18

19. Global 90-90-90 (2016)
19
ENDING AIDS PROGRESS TOWARDS THE 90-90-90 (Global AIDS Report 2017)
Joint United Nations Programme on HIV/AIDS (UNAIDS)

20. Global 90-90-90 (2016)
20
ENDING AIDS PROGRESS TOWARDS THE 90-90-90 (Global AIDS Report 2017)
Joint United Nations Programme on HIV/AIDS (UNAIDS)
(70% x 77% x 82%) =

21. Global 90-90-90 (2016)
% towards
Epidemic Control
44.2% 21
ENDING AIDS PROGRESS TOWARDS THE 90-90-90 (Global AIDS Report 2017)
Joint United Nations Programme on HIV/AIDS (UNAIDS)

22. Globally: Reductions in new infections are off target
NEW HIV INFECTIONS, ALL AGES, GLOBAL 1990-
2016 AND 2020 TARGET
22

23. Globally: Reductions in new infections are off target
NEW HIV INFECTIONS, ALL AGES, GLOBAL 1990-
2016 AND 2020 TARGET
23

24. Globally: Reductions in new infections are off target
NEW HIV INFECTIONS, ALL AGES, GLOBAL 1990-
2016 AND 2020 TARGET
24
“Fast-tracking Towards HIV Epidemic Control While
Maintaining Quality Health Care”

25. Where are we in Zambia?
• In Zambia, progress in improving knowledge of HIV status
(67%) in 2016 was lower than progress in other areas of
the cascade
• In 2016 more than 85% who knew there status were
accessing ART and of those, 89% were virally suppressed
• However, by June 2017, 900,653 HIV+ were on ART (MOH
HMIS)
25

26. Zambia 90-90-90 (2016)
% towards
Epidemic Control
50.7% 26

27. Road to Epidemic Control -Zambia
1990, 91,000
1993, 120,000
2003, 74,000
2016, 59,000
1990, 10,000
2003, 70,000
2016, 21,000
0
20,000
40,000
60,000
80,000
100,000
120,000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
New HIV Infections and AIDS Deaths (all ages, all populations)
New HIV infections (all ages) AIDS-related deaths (all ages)
27

28. Barriers to epidemic control
• Low identification of positives in high transmission age groups
• gaps in men and young people
• E.g. young women (10% of Population, aged 15–24 years) accounted
for 26% of new HIV infections
• Linkage to care still low
• High numbers of advanced disease at treatment enrolment
• Loss to follow up in care and low retention rates
• Viral load capacity limited
• Lack of structure to abolish stigma and discrimination
• Flat lining of resources
28

29. Moving ahead
• Improve case finding
• Targeted testing through Index Testing and Partner Notification Services (IT &
PNS)
• Enhance linkage to care
• Rapid initiation on ART (Tn’S, SDI)
• Improve retention and adherence
• Expand DSD models
• Improve monitoring
• Expand VL capacity
• Zero tolerance to stigma and discrimination
• Improving efficiencies and resource mobilization
29

30. ...