In 2014, UNAIDS rolled out the ambitious 90-90-90 target for 2020 in which “90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression”.
But how economically feasible is this goal?
In a panel discussion led by Michael Ruffler (a representative from PEPFAR), researchers provided their insight on the 90-90-90 goal and how it may be achieved.
Catherine Barker, a researcher from Palladium in Washington DC, seems skeptical about the potential of achieving this goal. Barker presented the scale-up of domestic financing required to reach the 90-90-90 target for 2020 in 97 countries. In order to achieve this goal, 17.6 billion dollars is needed internationally, with 6.1 billion dollars contributed from the 97 non-OCED countries studied. These estimates include the cost of arts, lab monitoring, frontline workers, as well as facility overheads. Barker suggests greater resource mobilization and technical efficiency in ARV development as well as changes in service delivery models to reduce the financial gap.
A representative from AVAC, Emily Donaldson, highlighted the importance of research and development in order to achieve the 90-90-90 goal. Her research involves tracking the investments from public, private and philanthropic funders for biomedical HIV prevention. This included HIV vaccines, pre-exposure prophylaxis (PrEP), and male circumcision.
Her results show that the global investment in HIV prevention has declined since 2012. Donaldson believes this is largely due to decreases in investment from the public sector in the US and throughout Europe. Her results also showed that the US is the single largest funder of all sectors, highlighting the need for a more diverse funding source. She concluded, “In a financial climate with increasingly limited resources, tracking investment in HIV R&D provides the field with vital information to chart the course forward. Monitoring funding trends allows identification of gaps, prioritization of research, analysis of the effect public policies have on funding trends and fact-based advocacy to support future R&D investments”.
These reports clearly show a strong need for domestic funding and push for R&D in order to achieve the UNAIDS 90-90-90 goal for 2020.