Older persons living with HIV (OPLWH) aged 50+ make more progress toward the UNAIDS 90-90-90 targets in four African countries


BACKGROUND: Achieving optimal HIV outcomes, as measured by UNAIDS 90-90-90 targets, is critical. Yet realizing 90-90-90 targets across all demographic groups is a challenge. Therefore, it is crucial to understand where further programmatic efforts are required to reach these goals.
METHODS: We examined 90-90-90 progress by sex and age (15-24, 25-49, 50+) in Eswatini, Malawi, Tanzania and Zambia via Population-based HIV Impact Assessment (PHIA) nationally-representative surveys conducted between 2015-2017. Demographic interview and clinical data and blood for HIV testing and viral load measurement were collected from consenting individuals (minors provided informed assent) from randomly-selected households. The 90-90-90 estimates included: HIV status awareness (first 90); antiretroviral therapy (ART) use among aware (second 90); and viral load suppression (<1,000 copies/milliliter) among ART users (third 90). Data were weighted using jackknife variance estimation. P-values were calculated using Wald test statistic on the log of the ratio of proportions with Bonferroni adjustment for multiple comparisons.
RESULTS: Overall, 78,815 individuals were interviewed: 51.3% female, 48.7% male, 36.8% 15-24 years, 49.1% 25-49 years, and 14.1% aged 50+. Achievement of 90-90-90 targets was more common among those 25 and older compared with 15-24 years and among women compared with men (Figure). The first 90 was achieved in Eswatini by all aged 50+ and women 25-49 years. The second 90 was achieved across countries among those aged 50+ and among women 25-49 years in Malawi, all ages in Tanzania, and Eswatini men 15-24 years. The third 90 was achieved across countries among those aged 50+ except Tanzanian women, and by all 25-49 years in Malawi, Zambia, and Eswatini except among Zambian men.

CONCLUSIONS: OPLWH were more likely to reach 90-90-90 targets than younger individuals. However, the shortfall in first 90 achievement spans all age groups, except in Eswatini, indicating expanded HIV testing across countries and ages is needed.