@article{fdi:010086780, title = {{A}chieving the {UNAIDS} 90-90-90 targets : a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce {HIV} transmission in sub-{S}aharan {A}frica}, author = {{S}abapathy, {K}. and {B}alzer, {L}. and {L}armarange, {J}oseph and {B}lock, {L}. and {F}loyd, {S}. and {I}wuji, {C}. and {W}irth, {K}. and {A}yles, {H}. and {F}idler, {S}. and {K}amya, {M}. and {P}etersen, {M}. and {H}avlir, {D}. and {D}abis, {F}. and {M}oore, {J}. and {H}ayes, {R}.}, editor = {}, language = {{ENG}}, abstract = {{B}ackground: {F}our large community-randomized trials examining universal testing and treatment ({UTT}) to reduce {HIV} transmission were conducted between 2012-2018 in {B}otswana, {K}enya, {U}ganda, {Z}ambia and {S}outh {A}frica. {I}n 2014, the {UNAIDS} 90-90-90 targets were adopted as a useful metric to monitor coverage. {W}e systematically review {I} the approaches used by the trials to measure intervention delivery, and estimate coverage against the 90-90-90 targets. {W}e aim to provide in-depth understanding of the background contexts and complexities that affect estimation of population-level coverage related to the 90-90-90 targets. {M}ethods: {E}stimates were based predominantly on "process" data obtained during delivery of the interventions which included a combination of home-based and community-based services. {C}ascade coverage data included routine electronic health records, self-reported data, survey data, and active ascertainment of {HIV} viral load measurements in the field. {R}esults: {T}he estimated total adult populations of trial intervention communities included in this study ranged from 4,290 ({T}as{P}) to 142,250 ({Z}ambian {P}op{ART} {A}rm-{B}). {T}he estimated total numbers of {PLHIV} ranged from 1,283 ({T}as{P}) to 20,541 ({Z}ambian {P}op{ART} {A}rm-{B}). {B}y the end of intervention delivery, the first-90 target (knowledge of {HIV} status among all {PLHIV}) was met by all the trials (89.2%-94.0%). {T}hree of the four trials also achieved the second- and third-90 targets, and viral suppression in {BCPP} and {SEARCH} exceeded the {UNAIDS} target of 73%, while viral suppression in the {Z}ambian {P}op{ART} {A}rm-{A} and {B} communities was within a small margin (similar to 3%) of the target. {C}onclusions: {A}ll four {UTT} trials aimed to implement wide-scale testing and treatment for {HIV} prevention at population level and showed substantial increases in testing and treatment for {HIV} in the intervention communities. {T}his study has not uncovered any one estimation approach which is superior, rather that several approaches are available and researchers or policy makers seeking to measure coverage should reflect on background contexts and complexities that affect estimation of population-level coverage in their specific settings.}, keywords = {{HIV} ; {A}ntiretroviral treatment ; {U}niversal {T}esting and {T}reatment ; {T}reatment as {P}revention ; {UNAIDS} 90-90-90 ; {AFRIQUE} {SUBSAHARIENNE} ; {BOTSWANA} ; {KENYA} ; {UGANDA} ; {ZAMBIE} ; {AFRIQUE} {DU} {SUD}}, booktitle = {}, journal = {{BMC} {P}ublic {H}ealth}, volume = {22}, numero = {1}, pages = {2333 [16 p.]}, year = {2022}, DOI = {10.1186/s12889-022-14713-5}, URL = {https://www.documentation.ird.fr/hor/fdi:010086780}, }