Skye McGregor

This session focused on indicators and metrics determining progress with elimination of HIV. This included the UNAIDS 95-95-95 targets in Australia, the impact of treatment interruptions on mortality in South Africa, HIV incidence among people who inject drugs in South Africa, and the impact of rapid treatment initiation in Thailand.

Using modelling data, Gray showed Australia is close to achieving the 95-95-95 targets in 2021: 91% diagnosed, 92% on treatment, and 98% with suppressed viral load. There was slow progress with diagnoses, and rapid improvements in treatment coverage, but stagnation since 2015. National data masks inequities in key populations. Moolla presented how unplanned treatment interruptions impacted mortality (South Africa IeDEA-SA cohort). Compared to no interruptions, mortality was 2.32x higher among early interrupters, and 1.9x higher among late interrupters. Male gender, age, and lower baseline CD4 count, and increased duration of interruption, were also associated with increased mortality. Using programmatic harm reduction services data from NACOSA, Aretenie showed high overall HIV incidence (13.7/100 person years) in South Africa, among people who inject drugs. Multivariate analysis showed province was the primary association for increased risk. Harm reduction and OST use were associated with decreased HIV risk. Teeraananchai presented the impact of ART initiation timing on virological failure, mortality, and loss to follow up, using Universal Health Coverage data. VF was higher in the treatment >3 months group, mortality lowest in the same day treatment initiation group, and LTFU highest in the same day and lowest in the >1-3 months treatment initiation group.

The studies suggested there is still substantial work to be done in achieving targets, with ongoing inequity – socio-economic, geographic, and demographic characteristics were associated with poorer outcomes and slower progress in indicators. Further research is needed to address gaps in access to prevention, lower uptake of rapid treatment initiation, disaggregation of national data to elucidate persistent disparities, and the use of viral load and quality of care data, to inform mortality outputs. It was recognised that the use of routine data facilitates analyses but there may be gaps in data collection or quality impacting the interpretation of study findings.