RESEARCH – November 2018

The UNAIDS criteria for monitoring HIV infection: situation in Estonia 2017

Authors: Irja Lutsar, Radko Avi, Pilleriin Soodla, Kristi Huik, Karolin Toompere, Margus Jääger, Kersti Kink, Kaisa Kirs, Heli Rajasaar, Svetlana Semjonova, Kai Zilmer

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The targets of 90-90-90 UNAIDS envisage that in case 90% of the people with HIV were tested, 90% of those tested would be initiated on antiretroviral therapy (ART), and 90% of those receiving ART would achieve viral suppression. High population-level viral suppression would be attained — the key to the test-and-treat strategy to eliminate the HIV epidemic.

We aimed to describe the situation in Estonia in terms of the goals of UNAIDS
90 : 90 : 90 in 2017 and to identify the factors that prevent achievement of these these goals.

Methods: We included all patients in the Estonian HIV-database (E-HIV) who, as of 01. October 2017, were alive and were receiving ART. The patients who had received at least one dose of ART conformed to the minimal effect population and those who received ART for at least 6 months and had viral load measurements within last 18 months conformed to maximal effect population. Viral suppression was expressed as total (viral load (VL) <100 copies/ml) and partial (VL 100-1000 copies/ml). Those with missing VL values were categorized as failures in minimal effect and were excluded from analysis of the maximal effect population.

Results: E-HIV contained the data of 4870 subjects of whom 4300 were alive; mortality rate 11.7%. In total, 3985 patients were receiving ART and thus 92.7% achieved the UNAIDS second 90% goal. The maximal effect population consisted of 2937 (68.3%) subjects. Altogether 2218 and 274 patients achieved total and partial viral suppression, respectively. Thus the UNAIDS third goal was achieved by 63% and 85% of the minimal and maximal effect population, respectively. The patients who did not achieve VL suppression were more likely treated in Ida-Virumaa, were HCV positive, were initiated on ART before 2014 or had lower CD4+ count and higher VL at ART initiation. Conclusion: In Estonia the UNAIDS second 90-90-90 goal has been achieved; more than 90% of the HIV-positive patients are receiving ART. In terms of the third goal, Estonia is close to achieving it among the maximal effect population but not among all treated patients. Further action should be taken to improve early identification of HIV infection, to ensure continuity of care and to provide equal opportunities in medical services across Estonia.