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J Int AIDS Soc. 2018 Mar;21(3). doi: 10.1002/jia2.25090.

A tale of two countries: progress towards UNAIDS 90-90-90 targets in Botswana and Australia.

Author information

Public Health, Burnet Institute, Melbourne, Vic., Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA.
Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Division of Global Health, Centers for Disease Control and Prevention, Gaborone, Botswana.
Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
Department of HIV Prevention and Care, Ministry of Health, Gaborone, Botswana.
Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Infectious Diseases Modelling, Burnet Institute, Melbourne, Vic., Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
International Centre for Reproductive Health, Ghent University, Ghent, Belgium.


UNAIDS 90-90-90 targets and Fast-Track commitments are presented as precursors to ending the AIDS epidemic by 2030, through effecting a 90% reduction in new HIV infections and AIDS-related deaths from 2010 levels (HIV epidemic control). Botswana, a low to middle-income country with the third-highest HIV prevalence, and Australia, a low-prevalence high-income country with an epidemic concentrated among men who have sex with men (MSM), have made significant strides towards achieving the UNAIDS 90-90-90 targets. These two countries provide lessons for different epidemic settings. This paper discusses the lessons that can be drawn from Botswana and Australia with respect to their success in HIV testing, treatment, viral suppression and other HIV prevention strategies for HIV epidemic control. Botswana and Australia are on target to achieving the 90-90-90 targets for HIV epidemic control, made possible by comprehensive HIV testing and treatment programmes in the two countries. As of 2015, 70% of all people assumed to be living with HIV had viral suppression in Botswana and Australia. However, HIV incidence remains above one per cent in the general population in Botswana and in MSM in Australia. The two countries have demonstrated that rapid HIV testing that is accessible and targeted at key and vulnerable populations is required in order to continue identifying new HIV infections. All citizens living with HIV in both countries are eligible for antiretroviral therapy (ART) and viral load monitoring through government-funded programmes. Notwithstanding their success in reducing HIV transmission to date, programmes in both countries must continue to be supported at current levels to maintain epidemic suppression. Scaled HIV testing, linkage to care, universal ART, monitoring patients on treatment over and above strengthened HIV prevention strategies (e.g. male circumcision and pre-exposure prophylaxis) will all continue to require funding. The progress that Botswana and Australia have made towards meeting the 90-90-90 targets is commendable. However, in order to reduce HIV incidence significantly towards 2030, there is a need for sustained HIV testing, linkage to care and high treatment coverage. Botswana and Australia provide useful lessons for developing countries with generalized epidemics and high-income countries with concentrated epidemics.


ARV ; 90-90-90 targets; Australia; Botswana; HIV care continuum; HIV testing; viral suppression

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