The goal of the strategy is nothing less than “ to end the AIDS epidemic as a public health threat by 2030” – an incredible advance from some 15 years ago, when the world set out to put three million people on antiretroviral therapy by the end of 2005.

In May 2016, in its 69th session, the World Health Assembly approved a new Global Health Sector Strategy on HIV for 2016–2021. By doing so, these systems can better meet the needs of all of their constituents – regardless of HIV status – in an era when many populations worldwide are living much longer with multiple comorbidities. Health systems everywhere need to become more integrated and more people-centered to successfully meet the needs of virally suppressed PLHIV. Good health-related quality of life for PLHIV entails attention to two domains: comorbidities and self-perceived quality of life. The new target would expand the continuum-of-services paradigm beyond the existing endpoint of viral suppression. We propose adding a ‘fourth 90’ to the testing and treatment target: ensure that 90 % of people with viral load suppression have good health-related quality of life. It thus fails to take into account the needs of PLHIV who have achieved viral suppression but still must contend with other intense challenges such as serious non-communicable diseases, depression, anxiety, financial stress, and experiences of or apprehension about HIV-related discrimination. However, it stops short of providing an explicit target for health-related quality of life. The WHO strategy calls for person-centered chronic care for people living with HIV (PLHIV), implicitly acknowledging that viral suppression is not the ultimate goal of treatment. It establishes 15 ambitious targets, including the ‘90-90-90’ target calling on health systems to reduce under-diagnosis of HIV, treat a greater number of those diagnosed, and ensure that those being treated achieve viral suppression. In 2016, the World Health Organization (WHO) adopted a new Global Health Sector Strategy on HIV for 2016–2021.

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