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From "3 by 5" to Universal Access Kevin M. De Cock Director, HIV/AIDS Department.

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Presentation on theme: "From "3 by 5" to Universal Access Kevin M. De Cock Director, HIV/AIDS Department."— Presentation transcript:

1 From "3 by 5" to Universal Access Kevin M. De Cock Director, HIV/AIDS Department

2 10 Years of HAART 25 Years of AIDS Epidemiologic Notes and Reports: Pneumocystis Pneumonia --- Los Angeles In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.

3 From "3 by 5" to Universal Access: outline Current status of HIV/AIDS treatment in the world Role of the health sector in working towards universal access Conclusions

4 Dr LEE Jong-Wook

5 Antiretroviral therapy coverage in low- and middle-income countries, June 2006 Geographical regionNumber of people receiving ARV therapy Estimated needCoverage Sub-Saharan Africa % Latin America and the Caribbean % East, South and South-East Asia % Europe and Central Asia % North Africa and the Middle East % Total %

6 20 low- and middle-income countries in sub-Saharan Africa, Asia, Latin America and the Caribbean treated more than 50% of those in need, June 2006

7 ARV Therapy: global need, June Sub-Saharan Africa Latin America and the Caribbean East, South and South-East Asia Europe and Central Asia North Africa and the Middle East 3 2 (Number of people in millions) Unmet need Receiving ARV therapy 70% of the total unmet need

8 Women's access to HIV treatment, June 2006 United Republic of Tanzania Mozambique Malawi Zimbabwe Zambia Central African Republic Botswana Kenya Côte d'Ivoire Namibia Rwanda Burundi South Africa Uganda Nigeria 10%40%50%60%70%20%30% Percentage of adults on ART who are womenPercentage of HIV-infected persons who are women

9 Children's access to HIV treatment, June 2006 Median: 8% Latin America Median: 8% Africa Median: 5 % Asia

10 Access to PMTCT services in sub-Saharan Africa, 2005 Guinea Bissau Zimbabwe Zambia Central African Republic Kenya Côte d'Ivoire Rwanda Swaziland Burundi Benin Togo 80 Namibia Uganda Gabon Lesotho Mozambique Percentage of HIV-infected pregnant women receiving ARV prophylaxis for PMTCT (Percentage coverage)

11 Treatment access among IDU in Eastern Europe Serbia and Montenegro Czech Republic Moldova Estonia Ukraine Lithuania Croatia Russian Federation IDU as % of people living with HIV IDU as % of people on ART

12 Equity of treatment access – knowledge gaps Coverage and quality of care in: Time Place Person

13 Estimated total annual resources available for AIDS, 1996–2005 PEPFAR Source: Lancet, 2006; 368: 526– World Bank MAP Launch Signing of Declaration of Commitment on HIV/AIDS Global Fund ( US$ millions )

14 Prices of ARV therapy

15 Comparison of outcome in patients on ART in high- and low-income settings 18 programmes in Africa, Asia, South America (4,810 pts), 12 cohorts from Europe and North America (22,217 pts) Low-income patients: - More females (51% vs 25%) - Lower CD4+ (108 vs 234 per cu mm) - More NNRTI (70% vs 23%) Source: ART-Link and ART-CC Groups; Lancet, 2006

16 Comparison of mortality in the months after starting ART in low- and high-income settings Source: ART-Link and ART-CC Groups; Lancet, (Log scale of mortality rate %) (Months from starting HAART) Adjusted hazard ratios

17 Source: WHO guidelines on antiretroviral therapy for HIV infection in adults and adolescents in resource-limited settings: towards universal access Recommendations for a public health approach, 2006 revision CD4 TESTING AVAILABLECD4 TESTING NOT AVAILABLE WHO CLINICAL STAGING Treat if CD4 count is below 200 cells/mm3 Do not treat 1 2 Consider treatment if CD4 count is below 350 cells/mm3 and initiate ART before CD4 count drops below 200 cells/mm3 T reat3 Treat irrespective of CD4 cell count Treat4 WHO: public health approach to initiating ART

18 Mortality in patients on ART in low-income settings 73% deaths occurred in persons starting therapy at CD4+ <100 per cu mm 38% deaths occurred in first month, 80% in first 4 months Source: ART-LINC and ART-CC Groups, Lancet, 2006

19 User fees and treatment outcome 1. Meta-analysis of 10 studies by Ivers LC et al.: Free laboratory testing did not affect outcome Free treatment was associated with 29-31% increase in viral load suppression Source: Ivers LC et al., CID, ART-LINC: 75% lower mortality at 1 year with free treatment Source: ART-LINC, Lancet, 2006

20 Countries implementing WHO HIV ResNet Drug Resistance protocols Resistance map

21 Tuberculosis in patients on ART 1. Incidence Six countries: 3.0 – 17.6 per 100 py South Africa: 3.4 per 100 py (CD4+ <200) 1.7 per 100 py (CD ) 2. Recurrence Côte dIvoire: 11.0 per 100 py Sources: Badri et al., Lancet, 2002; Seyler et al., Am J Respir Crit Care Med, 2005; Bonnet et al., AIDS, 2006

22 Priorities to reduce mortality of HIV/AIDS patients in low-income settings Expand HIV testing for earlier diagnosis Ensure essential package of care for HIV-infected patients, including TB screening and co-trimoxazole Provide ART for Stages 3 and 4 disease as early as possible Expand CD4+ testing for earlier initiation of ART Abolish user fees

23 Universal Access 2005 G8 Summit at Gleneagles, Final Communiqué: …working with WHO, UNAIDS and other international bodies to develop and implement a package of HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010.

24 Expanding testing and counseling Accelerating treatment scale up Maximising prevention Strengthening health systems STRATEGIC INF OR M A TIONSTRATEGIC INF TION The health sector's contribution to achieving Universal Access

25 AIDS cases, deaths and persons living with AIDS in the United States, (CDC) Deaths Persons living with AIDS AIDS Cases Years (AIDS cases and deaths in thousands) (Persons living with AIDS in thousands)

26 Health systems strengthening

27 WHO framework for monitoring the health sector: components of access Health interventions Availability: reachable and affordable ser- vices that meet a minimum standard Coverage: people using the intervention among those who need it Impact: reduction in new infection rates and improved survival of those infected

28 Testing and Counseling Family VCT Uganda Universal TC Lesotho Provider-initiated TC Kenya

29 Routine HIV testing in Botswana Routine testing in health care settings with right to decline was introduced in adults were interviewed 81-93% were in favour, said testing would be facilitated, treatment access enhanced 98% of persons tested expressed no regret Principal reasons for not testing: - fear ( 49%) - "no reason to believe infected" (43%) Source: Weiser SD et al, PLOS Medicine, 2006

30 Working towards universal access by 2010 Towards Universal Access


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