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Review
. 2020 Jan-Dec:19:2325958220919290.
doi: 10.1177/2325958220919290.

Estimating the First 90 of the UNAIDS 90-90-90 Goal: A Review

Maira Sohail  1   2 , Emily Bess Levitan  1   2 , Aadia Iftikhar Rana  1   3 , Sonya Lynn Heath  1   3 , Jeremiah Rastegar  1   3 , Mirjam-Colette Kempf  1   2   3   4   5 , Dustin Marsh Long  1   6
Affiliations
Review

Estimating the First 90 of the UNAIDS 90-90-90 Goal: A Review

Maira Sohail et al. J Int Assoc Provid AIDS Care. 2020 Jan-Dec.

Abstract

Estimating the population with undiagnosed HIV (PUHIV) is the most methodologically challenging aspect of evaluating 90-90-90 goals. The objective of this review is to discuss assumptions, strengths, and shortcomings of currently available methods of this estimation. Articles from 2000 to 2018 on methods to estimate PUHIV were reviewed. Back-calculation methods including CD4 depletion and test-retest use diagnosis CD4 count, or previous testing history to determine likely infection time thus, providing an estimate of PUHIV for previous years. Biomarker methods use immunoassays to differentiate recent from older infections. Statistical techniques treat HIV status as missing data and impute data for models of infection. Lastly, population surveys using HIV rapid testing most accurately calculates the current HIV prevalence. Although multiple methods exist to estimate the number of PUHIV, the appropriate method for future applications depends on multiple factors, namely data availability and population of interest.

Keywords: 90-90-90; HIV prevalence; HIV status; UNAIDS HIV estimates; undiagnosed HIV.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Process through which each method used to estimate the population undiagnosed with HIV.
Figure 2.
Figure 2.
Hypothetical illustration of calculating population undiagnosed with HIV. *Bars with years in () represents updated information about the 2016 population with people diagnosed that year but infected in 2016.
Figure 3.
Figure 3.
Hypothetical schematic figure of the CD4 depletion model. Time since infection estimated using CD4 count.
Figure 4.
Figure 4.
Test–retest method. Hypothetical timeline showing events from negative HIV test to positive HIV test.
Figure 5.
Figure 5.
Hypothetical schematic figure illustrating timeline of BED test. Dark area under the curve represents the window period of testing as “recent.”
See this image and copyright information in PMC

References

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