Progress in Reversing the HIV Epidemic through Intensified Access to Antiretroviral Therapy: Results from a Nationally Representative Population-Based Survey in Kenya, 2012

In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) called for 90% of persons living with HIV (PLHIV) to know their status, 90% of these to be on antiretroviral therapy (ART), and 90% of these to be virally suppressed by 2020 (90-90-90). It is not clear whether planned ART scale-up in c...

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Bibliographic Details
Published in:	PloS one 2016-03, Vol.11 (3), p.e0148068-e0148068
Main Authors:	Kim, Andrea A, Mukui, Irene, N'gan'ga, Lucy, Katana, Abraham, Koros, Dan, Wamicwe, Joyce, De Cock, Kevin M
Format:	Article
Language:	eng
Subjects:	Acquired immune deficiency syndrome Adolescent Adult AIDS Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Antiviral agents Biology and Life Sciences Comparative analysis Criteria Demographic aspects Disease prevention Drug therapy Epidemics Epidemics - prevention & control Female Guidelines Health aspects Health Care Surveys Health risks Health Services Accessibility HIV HIV infection HIV infections HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - prevention & control Human immunodeficiency virus Humans Kenya - epidemiology Male Medical diagnosis Medicine and health sciences Middle Aged People and Places Prevalence Surveys Therapy Young Adult
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Summary:	In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) called for 90% of persons living with HIV (PLHIV) to know their status, 90% of these to be on antiretroviral therapy (ART), and 90% of these to be virally suppressed by 2020 (90-90-90). It is not clear whether planned ART scale-up in countries whose eligibility criteria for ART initiation are based on recommendations from the 2013 World Health Organization treatment guidelines will be sufficient to meet UNAIDS' new global targets. Using data from a nationally representative population-based household survey of persons in Kenya we compared coverage and unmet need associated with HIV diagnosis, ART, and viral suppression among PLHIV aged 15-64 years in 2012 based on criteria outlined in the 2014 national ART guidelines and UNAIDS' 90-90-90 goals. Estimates were weighted to account for sampling probability and nonresponse. Eight in ten PLHIV aged 15-64 years needed ART based on treatment eligibility. Need for treatment based on the national treatment policy was 97.4% of treatment need based on UNAIDS' 90-90-90 goals, requiring an excess of 24,000 PLHIV to access treatment beyond those eligible for ART to achieve UNAIDS' 90-90-90 treatment target. The gap in treatment coverage was high, ranging from 43.1% nationally to 52.3% in Nyanza among treatment-eligible PLHIV and 44.6% nationally to 52.4% in Nyanza among all PLHIV. Maintaining the current pace of ART scale-up in Kenya will result in thousands of PLHIV unreached, many with high viral load and at-risk of transmitting infection to others. Careful strategies for reaching 90-90-90 will be instrumental in determining whether intensified access to treatment can be achieved to reach all who require ART.
ISSN:	1932-6203 1932-6203