Speaker
Description
In 2021, the Joint United Nations Programme on HIV and AIDS (UNAIDS) upgraded their original 90-90-90 targets set in 2014 to 95-95-95. These targets state that by 2025: (1) 95% of all people living with HIV (PLHIV) should be diagnosed; (2) 95% of all diagnosed PLHIV should be on antiretroviral therapy (ART); and (3) 95% of those on ART should be virally suppressed. While calculating the latter two numbers can be achieved using patient data, determining the first number is a non-trivial task due to several factors such as group differences in risk awareness, unknown times since infection when diagnosed (TI), systematic variation in TI among transmission modes and over calendar years, rate of disease progression, and influx of PLHIV from abroad. To estimate this first number, we expanded previous work on our multiple biomarker model to directly estimate the TI of a diagnosed PLHIV and subsequently estimate the HIV incidence and the number of undiagnosed PLHIV per year. These methods consider the individual's transmission mode and other demographic information to account for behavioural differences. We applied this methodology to assess Sweden's progress to the 95-95-95 target. We estimated the yearly HIV incidence and fraction of undiagnosed PLHIV in Sweden between 2003 and 2022, using biomarker data available in InfCareHIV, a national quality registry and research database of all diagnosed PLHIV since 2003 plus incomplete sampling going back to 1979. Furthermore, we determined which acquisition modes and demographics contribute most undiagnosed PLHIV and, therefore, where efforts must be focused to surpass the 95-95-95 target. Our work suggests that by 2022, 96% of all PLHIV in Sweden will have been diagnosed, of which 99% are on ART, with 98% being virally suppressed.
