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

Title
Older persons living with HIV (OPLWH) aged 50+ make more progress toward the UNAIDS 90-90-90 targets in four African countries
Presenter
Shannon M Farley
Authors
S.M Farley * (1), C. Wang (1), R. Bray (1), A. Low (1), S. Delgado (1), D. Hoos (1), R. Nyirenda (2), N. Wadonda (3), M. Li (4), M. Amuri (5), J.M Juma (6), N. Kancheya (7), K. Sleeman (8), H. Patel (8), K. Brown (8), A. Voetsch (8), W. El-Sadr (1), J. Justman (1)
Institutions
(1) Columbia University, ICAP, New York, United States, (2) Malawi Ministry of Health, Lilongwe, Malawi, (3) US Centers for Disease Control and Prevention (CDC), Lilongwe, Malawi, (4) US Centers for Disease Control and Prevention (CDC), Mbabane, Eswatini, (5) US Centers for Disease Control and Prevention (CDC), Dar es Salaam, Tanzania, United Republic of, (6) Ministry of Health, Community Development, Gender, Elderly and Children through The National AIDS Control Program, Dar es Salaam, Tanzania, United Republic of, (7) US Centers for Disease Control and Prevention (CDC), Lusaka, Zambia, (8) US Centers for Disease Control and Prevention (CDC), Atlanta, United States

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.