Background: The 90-90-90 targets aim to substantially decrease HIV transmission but it is unknown whether they can be achieved in urban communities with severe HIV epidemics. We report data from HPTN 071 (PopART), the largest programme delivering universal testing and treatment (UTT) in sub-Saharan Africa, to determine whether the targets have been reached after the three-year intervention.
Methods: PopART is a combination prevention intervention comprising annual rounds of home-based HIV testing delivered by Community HIV-care Providers (CHiPs) who also support linkage to care, ART retention and other HIV-related services. CHiP data from four communities in Zambia and three in South Africa receiving the full PopART intervention (including universal ART) were extrapolated to estimate the overall numbers of HIV-positive (HIV+) adults (15+) in these communities, the proportions who knew their HIV+ status (first-90) and the proportions of known HIV+ adults on ART (second-90), after the third annual round (R3:Sep 2016-Dec 2017) .
Results: By the end of R3, 75,472 (~100%) households had been visited by CHiPs, and 193,907 adult residents were enumerated of whom 139,951(72.2%) were contacted and consented to the intervention. Estimated total numbers of HIV+ adults (Table) were 9,332 men and 17,861 women, of whom 87% of men and 94% of women knew their HIV+ status following R3 (first-90) in Zambia, and 86% of men and 95% of women in South Africa. Among these, 88% of men and 89% of women were estimated to be on ART (second-90) by the end of R3 in Zambia, and 85% of men and 92% of women in South Africa. Estimates displayed by gender and age (Figure; illustrated for Zambia) show that both indicators were achieved or exceeded in older adults, but gaps remained in men aged 18-34 years and women aged 15-29 years.
Conclusions: After three rounds of intervention in these urban communities with high mobility and migration, we estimated that the first and second 90 targets were reached overall among women and almost reached among men. Continuing efforts are needed to reach the remaining HIV+ adults not yet diagnosed or on ART, particularly among younger adults where important gaps remain.

 Estimated number of HIV+ individuals/Total population (%)First 90: Immediately before R3 visit (%)First 90: End of R3 (%)Second 90: Immediately after R3 visit (%)Second 90: End of R3 (%)
ZAMBIA: Adults who participated Men:3,736/41,332 (9.0%)78977385
Women:9,395/56,345 (16.7%)82977789
Extrapolated to total population Men:6,244/64,704 (9.7%)75877988
Women:11,418/69,458 (16.4%)82947989
S AFRICA: Individuals who participated Men:1,557/17,813 (8.7%)77937084
Women:4.366/24,461 (17.8%)88978292
Extrapolated to total population Men:3,088/34,245 (9.0%)77867785
Women6,443/36,859 (17.5%)88958492
[90-90 estimates before/after R3 among individuals (age 15+) who participated in intervention and extrapolated to total adult population]

90-90 estimates before/after R3 extrapolated to total adult population, by age/gender (Zambian communities; data for S Africa will also be presented)
[90-90 estimates before/after R3 extrapolated to total adult population, by age/gender (Zambian communities; data for S Africa will also be presented)]

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