UNAIDS has established new program targets for 2025 to achieve the goal of eliminating AIDS as a public health threat by 2030. This study reports on efforts to use mathematical models to estimate the impact of achieving those targets.
We simulated the impact of achieving the targets at country level using the Goals model, a mathematical simulation model of HIV epidemic dynamics that includes the impact of prevention and treatment interventions. For 77 high-burden countries, we fit the model to surveillance and survey data for 1970 to 2020 and then projected the impact of achieving the targets for the period 2019 to 2030. Results from these 77 countries were extrapolated to produce estimates for 96 others. Goals model results were checked by comparing against projections done with the Optima HIV model and the AIDS Epidemic Model (AEM) for selected countries. We included estimates of the impact of societal enablers (access to justice and law reform, stigma and discrimination elimination, and gender equality) and the impact of Coronavirus Disease 2019 (COVID-19). Results show that achieving the 2025 targets would reduce new annual infections by 83% (71% to 86% across regions) and AIDS-related deaths by 78% (67% to 81% across regions) by 2025 compared to 2010. Lack of progress on societal enablers could endanger these achievements and result in as many as 2.6 million (44%) cumulative additional new HIV infections and 440,000 (54%) more AIDS-related deaths between 2020 and 2030 compared to full achievement of all targets. COVID-19–related disruptions could increase new HIV infections and AIDS-related deaths by 10% in the next 2 years, but targets could still be achieved by 2025. Study limitations include the reliance on self-reports for most data on behaviors, the use of intervention effect sizes from published studies that may overstate intervention impacts outside of controlled study settings, and the use of proxy countries to estimate the impact in countries with fewer than 4,000 annual HIV infections.
The new targets for 2025 build on the progress made since 2010 and represent ambitious short-term goals. Achieving these targets would bring us close to the goals of reducing new HIV infections and AIDS-related deaths by 90% between 2010 and 2030. By 2025, global new infections and AIDS deaths would drop to 4.4 and 3.9 per 100,000 population, and the number of people living with HIV (PLHIV) would be declining. There would be 32 million people on treatment, and they would need continuing support for their lifetime. Incidence for the total global population would be below 0.15% everywhere. The number of PLHIV would start declining by 2023.
John Stover and co-workers assess the potential health impacts of UNAIDS’ HIV/AIDS targets.
The previous UNAIDS strategic plan expired in 2020, creating a need for a new plan to guide efforts for the next 5 years.
Modeling contributed to the development of the new plan by assessing the epidemiological impact of proposed intervention coverage targets and estimating the financial resources needed to achieve them.
We applied mathematical simulation models to 77 high HIV burden countries to examine the effects of the proposed intervention coverage targets on trends in new HIV infections and AIDS-related deaths. The results were extended to a total of 173 countries to provide a comprehensive global analysis.
Results show that achieving the 2025 targets would reduce new annual infections by 83% (71% to 86% across regions) and AIDS-related deaths by 78% (67% to 81% across regions) by 2025 compared to 2010.
Progress on societal enablers (access to justice, prevention of stigma and discrimination, and prevention of gender-based violence [GBV]) is essential to achieve these targets.
Coronavirus Disease 2019 (COVID-19)–related disruptions could increase new HIV infections and AIDS-related deaths in the short term, but targets could still be achieved by 2025.
Although global efforts have failed to achieve the ambitious 2020 targets, it is still possible to achieve the 2030 goal of eliminating AIDS as a public health threat.
Many of the 2025 intervention coverage targets have already been achieved in some settings. Additional effort is required to accelerate progress in all countries and in all populations.