Hurdles in Meeting Goal to Cure HIV Worldwide

United Nations Program on HIV and AIDS seeks to reach 90% of HIV patients administered antiretroviral therapy to achieve durable viral suppression.

Insufficient capacity and underutilization of laboratory services may limit the ability to meet the Joint United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2020.

The 90-90-90 targets program calls for 90% of individuals with HIV to know their HIV status, 90% of all individuals who have been diagnosed to receive antiretroviral therapy (ART), and 90% of HIV patients receiving ART to achieve durable viral suppression.

In a study published in PLOS Medicine, researchers analyzed the responses of an annual survey between 2012 and 2014 sent to World Health Organization offices from 127 countries. Respondents were required to report on the capacity and usage of CD4 testing, HIV viral load (VL) testing, and early infant diagnosis in their country.

The findings showed that, although the capacity of available CD4 instruments were sufficient to meet the demand of people living with HIV/AIDS, the VL capacity was inadequate for covering needs in most of the reporting countries. Furthermore, even when the capacity was sufficient, the machines were underutilized.

Researchers found that only 13.7% of existing CD4 capacity, and 36.5% of existing VL capacity were utilized in 2013 in the reporting countries.

Some limitations to the study were that the responses were limited to national programs, and did not include the testing capacity in the private sector. Furthermore, incomplete or non-responses to the surveys limited the comprehensiveness of the survey data.

Authors noted their study was able to identify shortfalls in VL testing capacity and underutilization of CD4 and VL technologies, and provide a list of issues that need to be addressed in order to reach the UNAIDS targets.

“With laboratory systems in reporting countries expanding, a national laboratory strategic plan to strengthen services must be developed, implemented, and monitored by governments and their national and international partners,” said researcher Vincent Habiyambere. “The focus of international community, to ensure optimal use of laboratory technologies, should be on those countries where interventions for scaling up access to HIV diagnostic technologies are most needed.”