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Getting to 90–90–90: Experiences from the MaxART Early Access to ART for All (EAAA) Trial in Eswatini

  • Treatment as Prevention (SH Vermund, Section Editor)
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Abstract

Purpose of Review

The MaxART Consortium—led by the Eswatini Ministry of Health—implemented multiple interventions between 2012 and 2017 to achieve UNAIDS 90–90–90 targets. We summarize key findings from community outreach strategies in support of the first 90 goal, and from the Early Access to ART for All (EAAA) trial on the implementation of a “Treat All” strategy to achieve the second and third 90 goals within a government-managed public health system.

Recent Findings

The MaxART Consortium demonstrated that “Fast Track,” a problem-solving approach, was effective at increasing testing coverage in the community. Compared with baseline data at 3 months prior to the start of the Fast Track, there was a 273% proportional increase in HIV tests conducted among adolescent males, adolescent females, and adult men, and 722% over baseline for adolescent males. The MaxART EAAA trial further showed that implementation of the Treat All policy was associated with significant two-fold shorter time from enrollment into care to ART initiation than under the standard CD4+ cell threshold-based treatment guidelines. Finally, through the MaxART trial, Eswatini was able to identify areas for further investment, including addressing the system-side barriers to routine viral load monitoring, and designing and implementing innovative community-based approaches to reach individuals who were not more routinely accessing HIV testing and counseling services.

Summary

As low- and middle-income countries adopt the Treat All approach in their national HIV care and treatment guidelines, further implementation science research is needed to understand and address the system-level barriers to achieving the benefits of Treat All for HIV-infected individuals and those at risk.

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Author information

Authors and Affiliations

  1. Mesurado Cooperative, Cambridge, MA, USA

    Fiona Walsh

  2. Clinton Health Access Initiative (CHAI), 333 Dorchester Avenue, Boston, MA, USA

    Shaukat Khan

  3. Heidelberg Institute of Global Health, University of Heidelberg, 130.3 INF, 69120, Heidelberg, Germany

    Till Bärnighausen

  4. Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA

    Till Bärnighausen

  5. Africa Health Research Institute, KwaZulu-Natal, South Africa

    Till Bärnighausen

  6. Clinton Health Access Initiative (CHAI), Tsekwane St, Mbabane, Eswatini

    Anita Hettema & Charmaine Khudzie Mlambo

  7. Clinton Health Access Initiative (CHAI), Dakar, Senegal

    Charlotte Lejeune

  8. Eswatini National ART Program (SNAP), Ministry of Health, Mbabane, Eswatini

    Sikhathele Mazibuko

  9. Leiden University Medical Center, Leiden University, Leiden, Netherlands

    Ria Reis

  10. Amsterdam Institute for Social Science, University of Amsterdam, 1012 WX, Amsterdam, Netherlands

    Ria Reis

  11. Children’s Institute, University of Cape Town, Cape Town, South Africa

    Ria Reis

  12. aidsfonds, Condensatorweg 54, 1014 AX, Amsterdam, Netherlands

    Yvette Fleming

  13. Eswatini National Network of People Living with HIV (SWANNEPHA), P. O. Box 4161, Mbabane, Eswatini

    Gavin Khumalo

  14. SAfAIDS, Lamvelase Building, Nkoseluhlaza Street, Manzini, Eswatini

    Mandisa Zwane

  15. Directorate Office, Ministry of Health, Mbabane, Eswatini

    Velephi Okello

  16. Department of Biostatistics, Center on Methods for Implementation and Prevention Science, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA

    Donna Spiegelman

  17. Departments of Epidemiology, Biostatistics, Nutrition and Global Health, Harvard T.H Chan School of Public Health, Boston, MA, USA

    Donna Spiegelman

Authors
  1. Fiona Walsh
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Correspondence to Donna Spiegelman.

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All reported studies with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Walsh, F., Khan, S., Bärnighausen, T. et al. Getting to 90–90–90: Experiences from the MaxART Early Access to ART for All (EAAA) Trial in Eswatini. Curr HIV/AIDS Rep 17, 324–332 (2020). https://doi.org/10.1007/s11904-020-00501-6

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