Jason Asselin gave us a comprehensive overview of ACCESS, a national registry designed to pull HIV data from primary health care, sexual health clinic and the laboratory.

• his study included patients who had viral load testing within the last 12 months
• the last VL for the year was used to allow more patients to be included
• VL testiong as part of diagnosis was excluded
• demographics: males were older, females were younger
• results
• citeria for undetectable VL was met for 71% (2009) => 87% (2014)
• porportion of patients with a high viral load decreased
• similar outcomes for M vs F
• patients <40 years old were less like to achieve VL suppression compared to older patients
• weaknesses
• does not capture patients who did not engage in health service
• ACCESS will be rolled out nationally from Jul ’16 – Jun’19
• we can look forward to more comprehensive data

The opening plenary talk was given by Dr Valarie Delpech, who outlined the progress towards attaining treatment for all.

• the UNAIDS target for 2020 is 90-90-90
• 90% of patients diagnosed
• 90% of patients on ART
• 90% with viral suppression
• data from Levi et al (2016) showed
• 54% diagnosed, 41% on ART and 32% virally suppressed (2015 data)
• there appears to be a great disparity in the countries able to achieve this with many having poor rates of diagnosis and hence low rates of treatment/viral suppression
• Dublin declaration data: EU/EEA countries are performing better than the non-EU/EEA
• to date, no country has met the 90-90-90 goal (except claimed by Sweden)
• a major issue
• most countries have very little data about actual rates (even 4 decades into the epidemic)
• there is variation with data sources and quality of definitions/standard methodology

Has Australia met the W.H.O. guidelines on preventing HIV Mother to Child Transmission (MTCT)? This session looked at the current guidelines for antenatal care, management and rates of transmission.

As I work with antenatal and postnatal mums, I was interested in seeing if the current practices have had a positive effect on transmission rates. The answer...yes we have met the guidelines and reduced the rate of transmission.

Australian guidelines

1) HIV testing is conducted at the first antenatal appointment.

2) Clinical care of the mother include; CD4, VL, STI screening, starting ART and resistance testing

3) Strategies at birth; ART for the baby immediately, mode of birth decided by maternal VL, formula feeding exclusively. Baby to have HIV testing at 6 weeks and 3 months.

Surveillance of perinatal exposure

Data reviewed for the 30 years 1986-2016. 714 babies born to mothers who were HIV positive.

The rates of perinatal exposures are increasing, however the rates of babies with HIV have dropped significantly.

Rates of HIV testing has increased dramatically, and the exclusive use of formula feeding has also increased.

Conclusion

There has been an increase in the number of HIV positive mothers, but a reduction in the MTCT. Australia meets the W.H.O. targets. Which is fantastic news!

Currently around 88% of HIV positive patients are on ART.

500 HIV + men, 320 confirmed viral suppression for over 12 months, on ART long-term were asked to respond to the statement: “Being undetectable makes it unlikely that you can pass on HIV during unprotected sex.”

Only 25% believed that being virally suppressed made it unlikely that they can pass on HIV.

2 other studies supported these findings.

These are the patients we would expect are the most likely to know that they have low infectivity, yet consistently it appears they don’t.

Treatment as prevention - if we treated everyone as soon as they became infected, they would not be infectious and over time HIV would go away.

Where are we with our 90-90-90 UNAIDS targets?

This equates to 27 million people on ARVs globally.

Currently we are about 40% of that number.

Testing is difficult for countries like Australia and the UK.

Countries show large variability in the proportion of those on treatment.

Less variability by country in viral suppression of those on treatment.

Treatment guidelines are also inconsistent across the globe, where not everyone has adopted treatment for all.

There is lots of data missing from countries, and this is very basic surveillance data.

About 20,000 undiagnosed in UK, uptake of testing is poor.

3,000 new infections per year, would be reduced to 1,000 if we met our 90% diagnosed target.