Evaluating the HIV continuum of care and treatment in a low prevalence city in Iran: Kerman HIV-Friendly City initiative

Abstract

Background: The Kerman HIV-Friendly City (KHFC) is a five-year multi-disciplinary population-level intervention designed to meet the UNAIDS 90-90-90  targets by 2020. This study was a baseline assessment of the KHFC and analyzed the cascade of HIV testing, treatment and retention.
Methods: We reviewed reported HIV cases in Kerman city from 1997 to 2016. We calculated the numbers of cases with an HIV diagnosis, enrolled in HIV  care within six months, initiated on antiretroviral treatment (ART), retained on ART at 12 months, and with suppressed viral load after 12 months on ART. We estimated the number of people living with HIV (PLWH) using point and uncertainty intervals (UI) for national PLWH estimates.
Results: We estimated 1113 (UI 762-1982) PLWH in Kerman, of whom 437 (39.3%, UI 22.0 -57.3%) had been diagnosed, 347 (31.2%, UI 17.5-45.5%) had  enrolled in care, 190 (17.1%, UI 9.6-24.9%) had initiated ART, 112 (10.1%, UI 5.7-14.7%) remained on ART, and 81 (7.3%, UI 4.1-10.6%) were virally  suppressed.People who inject drugs (PWID) had the lowest indicators compared to other groups. In 2016, 23 people (43.5% male, 87.0% ≥25 years old, 17.4% PWID, and 26.1% heterosexuals) were diagnosed with HIV. Of these, 22 enrolled in care, 19 initiated ART, 18 remained on ART and seven were  virally suppressed.
Conclusion: HIV diagnosis is the biggest gap in the HIV continuum of care and treatment in Kerman. Recent improvements in HIV care and treatment  need to be intensified to achieve 90-90-90 targets.