HIV/AIDS Treatment and Care Clinical protocols for the WHO European Region 23 November 2007 World AIDS Day Jeffrey V. Lazarus WHO Europe, STI/HIV/AIDS Programme

Annual number of newly reported cases – all WHO EURO countries * Preliminary and incomplete data WHO/UNAIDS estimates, end of 2007: PLHIV: 2,360,000 (1.8–3.2m) Number of cases reported to WHO, end 2006: New HIV infections: New AIDS cases: New AIDS deaths:

Newly reported HIV cases, 1989  2006 HIV cases: AIDS cases: AIDS deaths: HIV cases: AIDS cases: AIDS deaths: HIV cases: AIDS cases: AIDS deaths: 7 533

Policy framework  Universal access by 2010 to HIV/AIDS prevention, treatment, care and support, 2006  Global STI Strategy  Dublin Declaration on Partnership to fight HIV/AIDS in Europe and central Asia (2004)  Global Health Sector Strategy for HIV/AIDS, 2003  UNAIDS/WHO “3 by 5” Initiative  UNGASS Declaration, 2001  Millennium Development Goals, 2000  Regional WHO resolutions

5 pillars for UA by 2010  1. Enabling people to know their HIV status through confidential HIV testing and counselling  2: Maximizing the health sector's contribution to HIV prevention  3: Accelerating the scale-up of HIV/AIDS treatment and care  4: Strengthening and expanding health systems  5: Investing in strategic information to guide a more effective response How WHO is working with countries to scale up HIV prevention, treatment, care and support:

HIV/AIDS Treatment and Care protocols for CIS countries  Developed and published in March 2004  Rationale –Scale up access to treatment and care –Availability of funds (GFTAM, WB) –Similar health care systems –No guidance at country level on provision of comprehensive HIV/AIDS treatment and care  Background for developing National Protocols

Process and progress  Series of technical consultations –HIV/AIDS Clinical Staging and AIDS case definition ( May 24-26, Copenhagen ) –Sexual and reproductive health for PLHIV ( June 1-3, Stresa, Italy ) –HIV/Hepatitis co-infection ( June 9-11, Lisbon ) –HIV/AIDS treatment for IDUs ( June 13-15, Lisbon ) –Vaccination of PLHIV ( June, Copenhagen )

Identified gaps  Clinical management of HIV/Hepatitis co- infection  Sexual and reproductive health for PLHIV  Vaccination of PLHIV  PMTCT for female IDUs

Identified chapters to be improved  HIV/AIDS treatment and care for IDUs  Management of TB/HIV co-infection  HIV testing and counselling  ART for adults

The result: 13 protocols Edited by Irina Eramova, Srdan Matic, Monique Munz  1. Patient evaluation and antiretroviral treatment for adults and adolescents  2. Management of opportunistic infections and general symptoms of HIV/AIDS  3. Palliative care for people living with HIV/AIDS  4. Management of tuberculosis and HIV coinfection  5. HIV/AIDS treatment and care for injecting drug users  6. Management of hepatitis C and HIV coinfection  7. Management of hepatitis B and HIV coinfection  8. Prevention of hepatitis A, B and C and other hepatotoxic factors in people living with HIV/AIDS  9. Support for sexual and reproductive health in people living with HIV/AIDS  10. Prevention of HIV transmission from HIV-infected mothers to their infants  11. Paediatric HIV&AIDS treatment and care  12. Immunization of people living with HIV/AIDS and people at risk of HIV infection  13. Post-exposure prophylaxis for HIV infection

Advocacy and strategic information

The goal