Julio Montaner has just presented his assessment on the roll out of 90:90:90 focusing on Canada but with global observations. The take home message is that transmission reductions are associated with greater roll out of therapy and higher rates of undetectable viral load. Achieving this is not easy and even in developed settings. People are now being explicit that 90:90:90 really means that only 73% of people with HIV are immune suppressed.
David Cooper has asked about what other strategies might be needed by countries with high rates, of treatment and viral suppression, to get incidence down. Julio, refereed to the the phylogenetic clustering work they are doing as a way of getting a better handle on this. He cautioned that PrEP may miss clusters.
Julio also discussed phylogenetic testing. Canada has high rates of prosecution for HIV transmission and they they are trying to change that. Changes in government may facilitate that. They got agreement form the Attorney General that data would not be used for prosecution.
This has resulted in data being collected without the fear of prosecution. They are hoping to adopt the same process across Canada. It might be useful to look at this in Australia as jurisdictions and research groups look to increasing phylogenetic monitoring.