OBJECTIVES : By 2030, the 95-95-95 UNAIDS goals are to achieve that 95% of people living with HIV are diagnosed, 95% of have access to HIV treatment, and 95% of them achieve sustained virologic suppression. We simulated the impact of different health interventions to improve the HIV continuum of care, increasing the percentage of people diagnosed, on treatment, and virally suppressed in Spain during the time frame 2020-2030.

METHODS : The analysis was developed by a multidisciplinary Expert Panel (1 epidemiologist, 2 infectious disease specialists & 1 hospital pharmacist) in three phases: 1) a comprehensive review of the literature; 2) several consensus meetings to select and define the interventions to be modelled, to evaluate their effectiveness and the target population according to structured questionnaires; and 3) an analytical decision model was designed to project the impact of implementing or strengthening these interventions to improve the HIV continuum of care through the creation of different scenarios for the period 2020-2030. Interventions were based on expanding the offer of rapid HIV test, training programs, electronic alerts, peer programs, multidisciplinary care and mHealth, among others. Effectiveness of the interventions was defined as the incremental percentage in diagnosis, treatment and viral suppression after implementation, targeting to the entire population or to specific high-risk population groups (heterosexuals, men who have sex with men, immigrants, female sex workers, transgender people and people who inject drug).

RESULTS : Eight interventions were prioritized for diagnosis in 3 years, 3 for treatment and 8 for viral suppression in the period 2020-2030, going from the current situation 86%, 93%, 90% (December 2016, most recent data available) to around 100% (remaining undetectable cases almost residual), 95% treatment, and 96% viral suppression.

CONCLUSIONS : Planification & prioritization of interventions based on baseline HIV cascade situation, could allow to achieve the 95-95-95 UNAIDS goals in Spain