Expanding ARV treatment in developing countries: Issues and Prospects NY-070626.001/020419VtsimSL001 NY-070626.001/020419VtsimSL001 Expanding ARV treatment in developing countries: Issues and Prospects Naisiadet Mason, MPH Human Rights/Advocacy Adviser HIV Dept, World Health Organization April 2004

NY-070626.001/020419VtsimSL001 Although there are drugs that can greatly prolong patients’ lives and well-being, these are not available…. Number of people that SHOULD BE under ARV treatment in developing countries (end 2003) Total 6 million Number of people that ARE under ARV treatment in developing countries (end 2003) Total 400,000 Deficit 5,600,000 AIDS deaths in 2002 Total 3.1 million

HIV/AIDS has been spreading fast... NY-070626.001/020419VtsimSL001 HIV/AIDS has been spreading fast... Number of people living with HIV/AIDS by 2002 Total 42 million …. and it is getting worse… People newly infected with HIV in 2002 Total 5 million AIDS deaths in 2002 Total 3.1 million

Prevention Treatment WHO Policies Human Rights / Ethics UNGASS 2001 NY-070626.001/020419VtsimSL001 Prevention Treatment WHO Policies Human Rights / Ethics UNGASS 2001 Goals 3 million by 2005

“Lack of access to antiretroviral treatment is a global health emergency”

It is possible to provide ARV treatment in resource-constrained environments... Examples Highlights 1. Brazil (1996-2002) 80% drop in the nº of hospitalizations per patient 50% drop in mortality 70% drop in morbidity Net savings of US$ 200 million 2. Medecins sans Frontiers (MSF) Pilot Projects in Malawi Adherence: 94% Average CD4 gain (18 months): 180 Utilization of nurses and non-medical health workers Adherence supported by community involvement (accompagnateurs) Average weight gain: 10,3 kg Increased demand for counselling and testing after program was introduced 3. Haiti (Partners in Health)

Expand the access to ARV treatment in developing countries NY-070626.001/020419VtsimSL001 Expand the access to ARV treatment in developing countries 3,000,000 people under ARV treatment by 2005

Resources currently available (outside WHO) NY-070626.001/020419VtsimSL001 Resources currently available (outside WHO) In US$ Regions GF (Rounds 1,2 & 3) i World Bank (MAP and non MAP) Sub-Saharan Africa 2,073,034,561 774,300,000 Latin America and the Caribbean 458,203,038 61,200,000 Eastern Europe and CIS 365,618,483 Asia, North Africa and Middle East 556,670,093 256,600,000 Total 3,453,526,175 1,092,100,000 i 5 Year Proposals

WHO Estimated number of people under ARV NY-070626.001/020419VtsimSL001 WHO Estimated number of people under ARV by 2005 with existing programs Baseline (Today) 300.000 Global Fund (Rounds 1, 2 and 3) 255.000 (by 2005)* Global Fund (Rounds 4 and 5) (+) 80.000 (by 2005)* World Bank (MAP) 70.000 (by 2005)* PEPFAR 200.000 (by 2005) Other initiatives 30.000 (by 2005) TARGETS * Presuming technical support; (+) funding to be confirmed Current programs…….…… 935,000 Gap…….…..2,065,000 A B Goal……..... 3,000,000

Rate of disbursement, Global Fund grants Rounds 1, 2 and 3 (as of Feb 10th 2004)

WHO has developed a strategy focusing on its core comparative advantages... Simplified treatment guidelines (global standard first and second line treatment regimens) as well as tools to track progress and impact of ARV treatment programmes (including drug resistance surveillance) Expanded training and capacity development for health professionals, and other cadres, including community support agents (full support to building critical mass of highly skilled trainers) Establish an AIDS Medicines and Diagnostics Service to assist countries to procure best priced quality drugs in simplest ways Strengthening health systems to support ART delivery (including drug procurement and distribution, capacity building, regulatory changes etc.)

Partners Group NGOs People living with HIV/AIDS Scientists / Research NY-070626.001/020419VtsimSL001 Partners Group NGOs People living with HIV/AIDS Scientists / Research Institutes Multilaterals (Global Fund, World Bank, UNAIDS, etc) Foundations Governments / Ministries of Health Private Sector bilaterals