BOSTON — The world’s medical community will have to come up with new and creative methods of administering care if it hopes to achieve UNAIDS’ ambitious 90-90-90 goal by 2020, said Anna Grimsrud, PhD, MPH, program specialist at the International AIDS Society in Cape Town, South Africa.

The UNAIDS Programme Coordinating Board established the 90-90-90 goal in 2013: Under this goal, by 2020, 90% of all people living with HIV should know their HIV status, 90% of all people with diagnosed HIV infection should be receiving sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy should have viral suppression.

The most recent estimates from UNAIDS estimates suggest that 15.8 million people are being treated with antiretroviral therapy and 36.9 million people globally are living with HIV. Along with the WHO’s announcement issued in September recommending antiretroviral therapy for all people with HIV, reaching the “90-90-90” targets while doubling the number of people in treatment will be a huge challenge.


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Speaking at CROI 2016, Dr Grimsrud said there a number of ways innovative interventions and “differentiated care” that are appropriate for the clinic and/or the community that can help the medical community meet its ambitious goals.

“Differentiated care is a set of adaptations that can be made to HIV health services with the intention of simplifying or streamlining care, including [antiretroviral therapy] delivery,” she said. “This is so that our services provide quality, patient-centered care, but also so that they reduce unnecessary burdens on the health care system. Innovations in ART are just one part of that. We need innovations in all stages in the cascade.”

Dr Grimsrud said that, at the community level, extending antiretroviral therapy refills, allowing patients to just visit a pharmacist rather than a clinician, home delivery of medication and community pharmacies are ideas to improve therapy coverage and adherence. In some treatment models, stable patients never have to come to the clinic, she said.

“If they’re stable and adherent in their treatment, they can get their clinical care, their clinical support and their ART in the community.,” said Dr Grimsrud. “We think this is one of the ways we’ll have to innovate and expand further, given that we’re trying to double our treatment cohort.”

Dr Grimsrud said that stable patients don’t need to be monitored as closely, so providing them with differentiated care or innovations in ART delivery reduces their burden on the health care system. That, in turn, allows healthcare providers to devote resources to parts of the cascade or to other patients but the patients that have traditionally had poorer outcomes.

“We don’t think innovations or differentiated care as being just for stable populations, we want to think about unstable populations, we want to think about subpopulations in patient characteristics,” she said. “We need to provide some of these differentiated solutions if we’re going to reach 90-90-90,” Dr Grimsrud said.

Reference

1. Grimsrud A. 122. Innovations in Antiretroviral Therapy Delivery. Presented at: CROI 2016. Feb. 22-25, 2016. Boston