ArticleAIDS (London, England)2020
Limitations of the UNAIDS 90-90-90 metrics: a simulation-based comparison of cross-sectional and longitudinal metrics for the HIV care continuum.
Article in AIDS (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- Antiretroviral Therapy Adherence Interventions in the Era of Universal Test and Treat: A Hybrid Systematic-Narrative Literature Review of Global Evidence.AIDS and behavior · 2026Pooled it
- Achieving 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-Saharan Africa.BMC public health · 2022Pooled it
- HIV continuum of care: expanding scope beyond a cross-sectional view to include time analysis: a systematic review.BMC public health · 2021Pooled it
- A Multistate Analysis of Longitudinal Care Outcomes Among People Newly Linked to Human Immunodeficiency Virus Care in Missouri.Open forum infectious diseases · 2026Article
- Retention in a low-resource, high-burden South African cohort on antiretroviral therapy: Retrospective, longitudinal analysis comparing six measures of retention.Journal of the International AIDS Society · 2025Article
- Transitions through the HIV continuum of care in people enrolling in care with advanced HIV disease in Latin America.IJID regions · 2025Article
- Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019.Annals of epidemiology · 2023Article
- Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011-2017.PLOS global public health · 2023Article
- A two-day workshop reviewing Canadian provincial and national HIV care cascade indicators, reporting, challenges, and recommendations.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2022Article
- Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019.The lancet. HIV · 2021Article
- Novel Longitudinal Methods for Assessing Retention in Care: a Synthetic Review.Current HIV/AIDS reports · 2021Review
- Social Networks and HIV Care Outcomes in Rural Kenya and Uganda.Epidemiology (Cambridge, Mass.) · 2021Article
Corrections and comments
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Authors and funding
12 authors at 8 institutions in 5 countries.
Funding
Abstract
objectivesThe Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 and other cross-sectional metrics can lead to potentially counterintuitive conclusions when used to evaluate health systems' performance. This study demonstrates how time and population dynamics impact UNAIDS 90-90-90 metrics in comparison with a longitudinal analogue.
designA simplified simulation representing a hypothetical population was used to estimate and compare inference from UNAIDS 90-90-90 metrics and longitudinal metrics based on Kaplan-Meier-estimated 2-year probability of transition between stages.
methodsWe simulated a large cohort over 15 years. Everyone started out at risk for HIV, and then transitioned through the HIV care continuum based on fixed daily probabilities of acquiring HIV, learning status, entering care, initiating antiretroviral therapy (ART), and becoming virally suppressed, or dying. We varied the probability of ART initiation over three five-year periods (low, high, and low). We repeated the simulation with an increased probability of death.
resultsThe cross-sectional probability of being on ART among persons who were diagnosed responded relatively slowly to changes in the rate of ART initiation. Increases in ART initiation rates caused apparent declines in the cross-sectional probability of being virally suppressed among persons who had initiated ART, despite no changes in the rate of viral suppression. In some cases, higher mortality resulted in the cross-sectional metrics implying improved healthcare system performance. The longitudinal continuum was robust to these issues.
conclusionThe UNAIDS 90-90-90 care continuum may lead to incorrect inference when used to evaluate health systems performance. We recommend that evaluation of HIV care delivery include longitudinal care continuum metrics wherever possible.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.