We estimated the HIV incidence reduction in Australia corresponding to achieving the UNAIDS 90-90-90 targets by 2020 and extended targets of 95-95-95 by 2030, in combination with various scale-ups of HIV testing, primary prevention and pre-exposure prophylaxis (PrEP) among high-risk men who have sex with men (MSM). These projections were evaluated against the target of achieving a 90% reduction in HIV incidence by 2030 compared with 2010 levels.
A mathematical model was used to project annual HIV incidence for combinations of HIV care cascade targets, testing frequencies, primary prevention coverages and levels of PrEP scale-up.
Achieving 90-90-90 by 2020 was estimated to reduce incidence by 10% from 2010 levels. Achieving 95-95-95 by 2030 was estimated to reduce incidence by 17% from 2010 levels, with the first 95 being achievable by testing low-/high-risk MSM two/four times per year respectively. This was improved to a 34% reduction by including a five-year scale-up of PrEP to 30% coverage among high-risk MSM; and to 45% by also increasing MSM condom use from 42% to 60%. However, even with 95-95-95, two/four tests per year for low-/high-risk MSM, 100% high-risk MSM PrEP coverage and 100% MSM condom use, only an 80% reduction in incidence was possible by 2030.
Many countries, particularly those with low HIV prevalence, will struggle to achieve a 90% reduction in HIV incidence by 2030 even if UNAIDS targets are met. Most will require substantially higher levels of prevention coverage and higher testing frequencies to reach this target.
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