The 90 90 90 strategy to end the HIV Pandemic by 2030: Can the supply chain handle it?

Abstract

Introduction: UNAIDS "90-90-90" strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. Reaching these targets by 2020 will reduce the HIV epidemic to a low-level endemic disease by 2030. However, moving the global response towards this universal test and treat model will pose huge challenges to public health systems in resource-limited settings, including global and local supply chain systems. These challenges are especially acute in Africa, which accounts for over 70% of the persons affected by HIV.

Discussion: From a supply chain perspective, each of the "90's" has possible complications and roadblocks towards realizing the promise envisioned by 90-90-90. For instance, ensuring that 90% of HIV-infected persons know their status will require a large increase in access to HIV tests compared with what is currently available. To ensure that there are enough anti-retrovirals available to treat the nearly 25 million people that will require them by 2020 represents a near doubling of the ARV supplied to treat the 13 million currently on treatment. Similarly, to monitor those on treatment means an unprecedented scale-up of viral load testing throughout Africa.

Conclusions: Larger issues include whether the capacity exists at the local level to handle these commodities when they arrive in the most severely affected countries, including considerations of the human resources and costs needed to make this strategy effective. We believe that such "real world" analysis of proposed strategies and policies is essential to ensure their most effective implementation.

Keywords: 90-90-90; HIV/AIDS; PEPFAR; commodities; supply chain management.

Figure 1

Decrease in price of first-line ARV treatment, 2006 to 2014. First line ARV regimens included in this table: Efavirenz/Emtricitabine/Tenofovir 600/200/300 mg [Atripla], tablets, 30 Tabs Efavirenz/Emtricitabine/Tenofovir 600/200/300 mg, tablets, 30 Tabs Efavirenz/Lamivudine/Tenofovir 600/300/300 mg, tablets, 30 Tabs Lamivudine/Nevirapine/Zidovudine 150/200/300 mg, tablets, 60 Tabs Lamivudine/Zidovudine/Efavirenz 150/300/600 mg, tablets, co-blister 60+30 Tabs Cost is aggregate cost/person-year of all regimens From Partnership for Supply Chain Management (PFSCM),un published analysis of procurement data, 2006 to 2014.