In 2016, countries around the world agreed to work toward 90-90-90 Fast-Track Targets set by UNAIDS, the Joint United Nations Programme on HIV and AIDS, to help ensure more people infected with HIV could access groundbreaking treatments and testing. Their targets were ambitious: by 2020, 90% of people living with HIV would know their status, 90% of those diagnosed would be receiving antiretroviral therapy (ART), and 90% of those on treatment would achieve viral suppression . Unfortunately, the world fell behind these 2020 goals with vast differences in achievement across countries, but UNAIDS continues to pursue its 95-95-95 targets of significantly reducing the spread of HIV with 200,000 new infections or fewer in 2030 .
While attention has focused on combatting COVID-19 over the last two years, HIV remains a global public health threat. In addition, the emergence of COVID-19 introduced new challenges to the fight to end HIV and AIDS. During a panel discussion at the 24th International AIDS Conference (AIDS 2022), experts representing Brazil, Nigeria, South Africa, and Uganda presented the impacts of COVID-19 on meeting UNAIDS goals in their countries. Despite regional differences, many similarities emerged from the discussion – both in terms of response and transferrable lessons for potential future implementation.
There is no cure for HIV, but the development of antiretroviral therapies (ART) in the late 1980s made it possible for people infected with HIV to live longer, healthier lives. ART suppresses HIV replication, reducing the amount of the virus in the body, or the viral load (VL). Successfully suppressed or undetectable VL allows the immune system of a person living with HIV to more effectively fight off infections and decreases the risk of further transmission. However, as the virus continues to evolve, growing HIV drug resistance (HIVDR) is a major concern and could threaten the efficacy of existing antiretroviral drug classes. For this reason, patient access to viral load testing, adherence to treatments, and prioritization of robust HIVDR surveillance programs among public health organizations remain crucial elements to the ongoing fight to end HIV.
The state of ART adherence and resistance across global hotspots
Between border closures, stay-at-home orders, shipping delays, staffing shortages, limited PPE and the risk of exposure to the virus itself, COVID-19 disrupted HIV care globally.
During the panel, Dr. Carlos Brites, Professor of Infectious Diseases, School of Medicine, Federal University of Bahia (UFBSA) in Brazil, described how many previously adherent patients stopped ART due to COVID-related factors. The numbers of patients beginning ART and viral load tests performed declined during this period, as many patients skipped medical appointments. “We tried to look at the reasons for missing scheduled visits, and the main reason was the fear of COVID contamination,” explained Dr. Brites.
Those living with HIV were also affected as resources were redeployed to combat the spread of COVID-19. In her presentation, Mandisa Dukashe, Founder and Director of HIV Survivors and Partner Network (HSPN) in South Africa, reported that PCR instruments used for HIV viral load testing were repurposed to test for COVID-19 during the pandemic, while gene sequencing platforms established for HIVDR testing were redeployed for SARS-CoV-2 variant identification.
Learnings from COVID-19 could support HIV
Closing out the session, the presenters came together to discuss lessons learned from managing HIV during the COVID-19 pandemic as countries resume work to meet the UNAIDS 2030 goals.
As a result of the pandemic, many low- and middle-income countries saw an increase in investment from global public health groups. The equipment and resources now available in these countries could enable increased viral load testing and drug resistance surveillance, key tactics for managing HIV across populations and ensuring drugs retain their efficacy.
Putting patients first and ensuring that treatment was accessible, through strategies including dispensing multi-month ART and establishing community distribution points, also proved crucial. “We need to put people at the center of the services they need,” remarked Dr. Olabanjo Ogunsola, Associate Director and Head of the Prevention and Community Directorate, APIN Nigeria. Going forward, HIV education is needed so people living with the disease are empowered to take part in their own care.
Continued patient monitoring and a quick, efficient response to developing HIVDR also remain critical. “The best way to prevent drug resistance is adherence,” said Dr. Cissy Kityo Mutuluuza, Executive Director, Joint Clinical Research Centre, Uganda. “But, in the long term, we need to continue – as government, as ministries of health, as program people – we need to continue monitoring and doing surveillance for drug resistance.”
To hear global perspectives on HIV management, watch the panel discussion from the 24th International AIDS Conference on demand.
For information on Thermo Fisher Scientific’s HIV genotyping solutions to support surveillance efforts and combat HIV drug resistance, please visit us at https://www.thermofisher.com/hivdr.