Evaluating the Use of 90-90-90 for HIV Policy in the Asian Context

UNAIDS recommends the 90-90-90 policy for controlling HIV infection (identify 90% of HIV cases, provide care for 90% of these, and have 90% of the treated achieve viral suppression). 90-90-90 requires an accurate measurement of HIV prevalence, which is impossible to achieve. Prevalence must be estimated. Customarily, 90-90-90 prevalence estimates are based on point estimates at the midpoint of a credible range of high and low estimates. This paper examines the effect of the high and low estimates on 90-90-90. We examined the impact on policy goal based on 90% of the point estimate, if the true prevalence were the credible range’s high or low estimate. This was calculated for 14 Asian Countries (Afghanistan, Cambodia, Indonesia, Iran, Kazakhstan, Laos Malaysia, Myanmar, Nepal, Pakistan, Philippines Thailand, Uzbekistan, Viet Nam) that UNAIDS estimated point prevalence of prevalence greater than 10,000 persons. If the low estimate for the 14 countries was the true prevalence, 11 of the countries could not achieve 90% of the point estimate because the low prevalence was less than 90% of the point estimate. The other three countries, would have to identify 97.5% to 99.0% of infected persons to achieve 90% of the point prevalence. If the true prevalence is the high estimate, twelve of the countries would have identified only 76.8% to 84.9 of the true prevalence. Afghanistan (26.0%) and Iran (40.8%) would have identified far fewer persons than the point estimate goal. Therefore 90-90-90 should be considered to be non-evaluable and should not be used for policy making.