In 2014, the Joint United Nations Programme on HIV and AIDS (UNAIDS) established the 90-90-90 targets, which sets the goal that by 2020, 90% of all people living with HIV (PLWH) should be aware of their HIV status, 90% of all diagnosed PLWH should be accessing antiretroviral therapy (ART), and 90% of all patients receiving ART should have suppressed viral loads (1). Correspondingly, the Chinese government developed an action plan for 2016-2020 to meet the 90-90-90 targets and to control the national HIV epidemic. As part of this effort, the Chinese National Free Antiretroviral Treatment Program eliminated the CD4 cell count eligibility threshold and began offering free treatment to all PLWH starting in 2016 (2).
Every year, the National Center for AIDS/STD Control and Prevention (NCAIDS) of Chinese Center for Disease Control and Prevention, compiles data from the nationwide HIV/AIDS Comprehensive Response Information Management System (CRIMS) (3) and convenes experts to evaluate the state of the epidemic and the national response (Table 1). Data on China’s progress towards the 90-90-90 targets are shared with international organizations, including UNAIDS and the World Health Organization (WHO). As of the end of 2018, estimates for the three target indicators stand at 68.9% (61.5%-78.3%), 83.4%, 94.2%, respectively. Progress towards the first 90% target lags behind the second and third targets. Testing strategies need to be tailored and strengthened so that more PLWH can be screened and diagnosed in a timely manner.
Numerator Denominator First 90%: Diagnosis Number of surviving PLWH with a confirmed HIV diagnosis, taken from CRIMS. Number of PLWH estimated through Spectrum modelling, figures were taken from the joint estimation group. Second 90%: Treatment Number of PLWH on ART, taken from CRIMS. Number of surviving PLWH with a confirmed HIV diagnosis, taken from CRIMS. Third 90%: Viral Suppression Number of PLWH with viral load ≤1,000 copies/mL, taken from CRIMS. Number of PLWH on ART for at least 12 months and at least one viral load test result*, taken from CRIMS. * The calculation of the third 90% is different from the UNAIDS recommendation. The Chinese National Free Antiretroviral Treatment Program provides free viral load testing once a year. Patients newly initiated on ART may not have received a viral load test by the end of the reporting period (4).
Table 1. Definitions of the 90-90-90 targets, calculated each calendar year using CRIMS data.
The number of HIV tests performed annually has increased from 128 million in 2014 to 241 million in 2018 (Figure 1). For this same period, CRIMS data report that the total survival number of PLWH with a confirmed diagnosis increased from 500,679 to 861,042 (Table 2), and the number of newly diagnosed cases per calendar year rose from 103,501 in 2014 to 148,589 in 2018 (Figure 1). CRIMS data on the care continuum are presented in Table 2. A joint assessment by NCAIDS, UNAIDS and WHO used Spectrum modelling to estimate that at the end of 2018, the total number of PLWH in China was 1,250,000 (1,100,000-1,400,000). The percentage of PLWH with a confirmed HIV diagnosis at the end of 2018 in China was 68.9% (61.5%-78.3%). There were an estimated 81,000 (60,000-105,000) new infections in 2018 and the estimated national prevalence in 2018 is 0.090% (0.079%-0.101%).
Items 2014 2015 2016 2017 2018 Total survival number of PLWH 500,679 577,423 664,751 758,610 861,042 PLWH on ART 295,358 386,756 494,657 609,829 718,499 Patients on ART eligible for viral load testing 216,576 285,237 359,337 447,720 573,992 Patients on ART with ≥1 viral load test result 197,735 263,712 255,924 362,970 512,499 Patients with suppressed viral load 179,807 241,003 237,696 339,510 482,954
Table 2. China’s continuum of HIV care, 2014–2018
The number of people receiving ART increased from 295,358 in 2014 to 718,499 in 2018 (Table 2), corresponding to treatment coverage of 59.0% in 2014 and 83.4% in 2018 (Figure 2). Over 90% of patients on ART for over 12 months have suppressed viral loads, and this percentage rose to 94.2% in 2018.