90-90-90 targets

90-90-90 targets
Name	90-90-90 targets
Caption	UNAIDS schematic representation of the 90-90-90 cascade
Established	2014
Initiator	Joint United Nations Programme on HIV/AIDS
Goal	Diagnose 90% of people living with HIV, treat 90% of diagnosed, achieve viral suppression in 90% of treated

90-90-90 targets The 90-90-90 targets were an international public health initiative aimed at accelerating the response to the Human immunodeficiency virus pandemic by setting measurable milestones for diagnosis, treatment, and viral suppression. Launched by the Joint United Nations Programme on HIV/AIDS in 2014, the targets sought to unify efforts across multilateral agencies, national programmes, philanthropic actors, and civil society organizations. The framework influenced policy among institutions such as the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and foundations like the Bill & Melinda Gates Foundation.

Background and origins

The targets emerged amid declining AIDS mortality following the scale-up of antiretroviral therapy promoted by the President's Emergency Plan for AIDS Relief and guided by evidence from randomized trials at institutions like the International AIDS Society conferences. Influences included epidemiological modelling from teams associated with the Imperial College London, programmatic lessons from Médecins Sans Frontières, and goal-setting trends exemplified by the Sustainable Development Goals agenda. Political endorsement came from UN assemblies and bilateral partnerships including the United States Agency for International Development and national ministries such as the South African Department of Health.

Targets and definitions

The framework defined three numerical benchmarks: diagnose 90% of all people living with HIV, provide sustained antiretroviral therapy to 90% of those diagnosed, and achieve viral suppression for 90% of those on treatment, forming a cascade concept influenced by care continuum models used by researchers at institutions like the Centers for Disease Control and Prevention and the Harvard School of Public Health. Measurement relied on surveillance systems employed by agencies including UNAIDS and data repositories coordinated with academic groups at the Johns Hopkins Bloomberg School of Public Health and the London School of Hygiene & Tropical Medicine.

Implementation and strategies

Implementation combined approaches from community mobilization exemplified by Act Up, differentiated service delivery piloted in programs in partnership with Clinton Health Access Initiative and supply-chain optimization strategies used by the Global Fund. Testing innovations drew on protocols from the World Health Organization and point-of-care diagnostics promoted by companies working with Gavi, the Vaccine Alliance, while treatment scale-up leveraged procurement models advocated by UNICEF and logistics systems refined through partnerships with the World Bank.

Global progress and outcomes

By the target deadline year, aggregated reports from UNAIDS and country submissions to bodies like the United Nations General Assembly indicated substantial progress in many settings, with notable gains in countries such as Rwanda, Botswana, Zambia, Eswatini, and Uganda. Evaluations published in journals with contributions from researchers affiliated with University of California, San Francisco, Oxford University, and the University of Nairobi documented reductions in HIV-related morbidity and transmission where cascade milestones were met, and informed policymaking at forums including the International AIDS Conference.

Challenges and criticisms

Critiques arose from civil society and academic voices, including scholars at Yale University and advocacy groups like the Treatment Action Campaign, arguing that the targets risked obscuring structural determinants highlighted in analyses by Amartya Sen-influenced health equity frameworks and by researchers at the London School of Economics. Operational challenges included data quality concerns noted by World Health Organization assessments, stigma barriers analyzed by teams at the London School of Hygiene & Tropical Medicine, and funding volatility discussed in reports by the Global Fund and the Bill & Melinda Gates Foundation.

Regional and national adaptations

Countries and regions adapted the framework to local epidemiology and health systems: the European Centre for Disease Prevention and Control integrated cascade indicators into regional surveillance, the Ministry of Health (Kenya) implemented community testing pilots with partners such as Population Services International, and municipal programmes in cities like New York City and London tailored linkage-to-care interventions informed by research at the Columbia University Mailman School of Public Health.

Legacy and successor goals (95-95-95)

The initiative's measurable cascade model directly informed the adoption of more ambitious targets such as the 95-95-95 goals advanced by UNAIDS and debated in forums including the United Nations High-level Meeting on HIV/AIDS. Lessons from implementation influenced strategic guidance produced by the World Health Organization, financing priorities set by the Global Fund, and operational plans at national ministries such as the South African Department of Health, shaping the global response to HIV into subsequent decades.

Category:HIV/AIDS public health