1. World Health Organization "3 by 5" Target http://www.who.int/3by5 Access to HIV/AIDS Medicines The 3x5 strategy WHO/EDM Technical Briefing Seminar

2. World Health Organization "3 by 5" Target http://www.who.int/3by5 Content of the presentation Challenges: how serious is the HIV/AIDS pandemic? Opportunities: What is the global response to address the challenges? What is 3by5? What are the roles of the AMDS and EDM in 3by5 ?

3. World Health Organization "3 by 5" Target http://www.who.int/3by5 Challenges Magnitude Numbers Treatment gap Cost Capacity required

4. World Health Organization "3 by 5" Target http://www.who.int/3by5 GlobalAIDS epidemic 1990−2003 Global AIDS epidemic 1990−2003 0 10 20 30 40 50 19901991199219931994199519961997199819992000200120022003 Millions Number of people living with HIV and AIDS 0.0 1.0 2.0 3.0 4.0 5.0 Year % HIV prevalence adult (15-49) Source: UNAIDS/WHO, 2004 Number of people living with HIV and AIDS % HIV prevalence, adult (15-49) 2004 Report on the Global AIDS Epidemic (Fig 1) Challenges

5. 00003-E-5 – July 2004 About 14 000 new HIV infections a day in 2003 l More than 95% are in low and middle income countries l Almost 2000 are in children under 15 years of age l About 12 000 are in persons aged 15 to 49 years, of whom: — almost 50% are women — about 50% are 15–24 year olds Challenges

6. 00003-E-6 – July 2004 Global summary of the HIV and AIDS epidemic, D ecember 2003 The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. Number of people living with HIV in 2003Total37.8 million (34.6 – 42.3million) Adults35.7 million (32.7 – 39.8 million) Children under 15 years2.1 million (1.9 – 2.5 million) People newly infected with HIV in 2003 Total4.8 million (4.2 – 6.3 million) Adults4.1 million (3.6 – 5.6 million) Children under 15 years630 000 (570 000 – 740 000) AIDS deaths in 2003Total2.9 million (2.6 – 3.3 million) Adults2.4 million (2.2 – 2.7 million) Children under 15 years490 000 (440 000 – 580 000) Challenges

7. Yearly deaths as a factor of total in 1995 0.0 0.5 1.0 1.5 2.0 Introduction of Highly Active Antiretroviral Treatment (HAART) AIDS Deaths in Africa AIDS Deaths in Western Europe 19921991199919931995199419961997200119982000 Source: Adapted from WHO/UNAIDS Statistics & HIV/AIDS Surveillance in Europe, End-year report 2001, No 66, CESES Widening Gap of AIDS Treatment 2003 Challenges

8. 400,000 people on treatment: 7% coverage 0 10 20 30 40 50 60 % Source: UNAIDS/WHO, 2004 Antiretroviral therapy coverage for adults, end 2003 AfricaAsiaLatin America and the Caribbean Eastern Europe and Central Asia North Africa and Middle East 2004 Report on the Global AIDS Epidemic (Fig 33) Challenges

9. World Health Organization "3 by 5" Target http://www.who.int/3by5 High burden countries in need of ART, Nov 2003

10. 0 5,000 10,000 15,000 20,000 2004200520062007 Latin America and the Caribbean Eastern Europe and Central Asia North Africa and Middle East East Asia and the Pacific South and South-East Asia Sub-Saharan Africa Source: UNAIDS, 2004 Projected annual HIV and AIDS financing needs by region, 2004 − 2007 (in US$ million) US$ millions 2004 Report on the Global AIDS Epidemic (Fig 35) Challenges

11. World Health Organization "3 by 5" Target http://www.who.int/3by5 Opportunities Shifts Political will Prices Positive stories "Pecunia"

12. Source: UNAIDS/WHO, 2004 2 000 4 000 6 000 8 000 10 000 12 000 14 000 0 Price US$ Jun 00 Oct 00 Feb 01 Apr 01 Dec 00 Nov 00 Jul 01 Mar 03 Sep 98 Aug 98 Jul 98 Oct 03 Jun 98 Sep 03 Jan 01 May 01 Aug 01 Mar 10 Jun 01 Launch of Accelerating Access Initiative (AAI) Negotiatiations with R & D Pharma within AAI Generic companies’ offer of price reduction to Uganda Further price reductions by AAI companies Further discussion with generic companies Negotiations by William J. Clinton Foundation with 4 generic companies Mar 01 Apr 01 Oct 03 Jun 01 May 01 Feb 01 Jan 01 Dec 00 Nov 00 Jul 01 600 700 800 900 1 000 1 100 1 200 500 Price US$ 400 300 200 100 0 Prices (US$/year) of a first-line antiretroviral regimen in Uganda: 1998−2003 2004 Report on the Global AIDS Epidemic (Fig 34) Opportunities

13. 0 3,000 6,000 9,000 12,000 15,000 1998 Before ART 2002 ART started 0 5 10 15 20 25 19982002 Khayelitsha: Availability of decentralized antiretroviral therapy (ART) access, advocacy, and multi-disciplinary support services dramatically increases demand for testing and counselling HIV tests Support groups Source: WHO, 2004 (courtesy of Dr. Fareed Abdullah) 2004 Report on the Global AIDS Epidemic (Fig 27) Opportunities

14. The Global Fund to Fight AIDS, Tuberculosis and Malaria Pledges and contributions received, as of December 31, 2003 EC 11% Italy 9% Germany 7% U.K. 6% Other Govt’s 7% Japan 5% Netherlands 3% Canada 2% Corporate/Private* 2% France 14% U.S. 33% EC 19% Italy 10% Germany 2% U.K. 6% Other Govt’s 10% Japan 8% Netherlands 2% Canada 2% Corporate/Private* 5% France 6% U.S. 30% Total pledges: US$ 4,966 million Total contributions received: US$ 2,104 million *Foundations and Non-for-profit organizations, Corporations, and Individuals, Groups and Events Source: THE GLOBAL FUND ANNUAL REPORT 2003, January 1 - December 31, 2003. 2004 Report on the Global AIDS Epidemic (Fig 42) Opportunities

15. World Health Organization "3 by 5" Target http://www.who.int/3by5 Treatment Works Dec 2002 Mar 2003 Opportunities

16. World Health Organization "3 by 5" Target http://www.who.int/3by5 What is 3by5 Target and goal Strategic Areas Funding requirements Approach –Role of AMDS –Role of EDM

17. World Health Organization "3 by 5" Target http://www.who.int/3by5 38 million people living with HIV/AIDS worldwide 6 million people are in need of antiretroviral treatment (ART) 440,000 people have access to treatment 3 million people die every year because they can not get the treatment ART prolongs lives of people with HIV/AIDS enabling them to lead a productive life. ART makes HIV/AIDS a chronic and manageable disease, not a death sentence. The "3 by 5" Target, what and why? The Goal: Provide access to treatment for all The Target: Treat 3 million people with AIDS, by the end of 2005

18. World Health Organization "3 by 5" Target http://www.who.int/3by5 "3 by 5" Strategic Areas simplified and standardized tools Providing simplified and standardized tools and guidelines on antiretroviral treatment AMDS - AIDS Medicines and Diagnostics Service Creating AMDS - AIDS Medicines and Diagnostics Service to ensure effective and reliable supply of medicines and diagnostics new knowledge and successful strategies Rapid identification, dissemination and application of new knowledge and successful strategies support to countries Urgent and sustained technical support to countries Providing assistance to countries for capacity building and training Providing assistance to countries for capacity building and training

19. World Health Organization "3 by 5" Target http://www.who.int/3by5 A Simple Two-Pronged Approach Country Driven Scale-up & treatment happens in country. It is country driven Government are responsible for the care and treatment of their citizens, including the poor and marginalized Multiple actors are involved in ART and with scale-up WHO provides technical support to governments Focus on UNAIDS "Three Ones" approach  One National Plan  One Coordinating Body  One Monitoring and Evaluation System

20. World Health Organization "3 by 5" Target http://www.who.int/3by5 Simplification A Simple Two-Pronged Approach Simplified treatment Limited number of first line treatments Fixed Dose Combination (FDC) support adherence Simplified procurement and supply management Help countries streamline procurement and supply (AMDS) WHO Procurement, Quality and Sourcing Project (pre-qualification) E-procurement

21. World Health Organization "3 by 5" Target http://www.who.int/3by5 AMDS in Focus A project of UNAIDS, WHO, UNICEF the World Bank and other partners A network for support in: Strategic information e.g. on sources, prices, raw materials, patent status Developing Stockpiles and pooled procurement Demand forecasting Technical support for product selection, procurement, supply-management and local production Prequalification of ARVs and diagnostics

22. World Health Organization "3 by 5" Target http://www.who.int/3by5 AMDS Secretariat Clearinghouse on ARV drugs and HIV diagnostics. Brokerage of collaboration between partners and countries (or organizations in countries ). Support collaboration between partner organizations. Fundraise for AMDS activities by all partners. Advocate for investment in PSM, as a critical element for the fight against AIDS

23. World Health Organization "3 by 5" Target http://www.who.int/3by5 Partners so far Informal partners group –UN Agencies WHO (EDM, EHT, CPS, Regional offices), UNICEF, World Bank, UNAIDS, UNFPA, UNDP –Technical organizations and donor agencies JSI, IDA, GFATM, MEDS, EPN, CHAI, Crown Agents –Observers MSF, US State Department ( PEPFAR), USAID –Secretariat AMDS unit of HIV Department of WHO –New offers for collaboration CCAR, FIP, CPA

24. World Health Organization "3 by 5" Target http://www.who.int/3by5 EDM Selected areas of (in)direct importance to HIV (1) Country support –Essential Medicines Programmes in 110 countries –NPOs in 40 countries Training –RDU (professional and in community) –National regulatory agencies and drug quality control laboratories –Best practices in supply and distribution systems –Pharmacovigilance

25. World Health Organization "3 by 5" Target http://www.who.int/3by5 EDM Selected areas of (in)direct importance to HIV (2) Evidence based tools, guidelines, TA –Model list of Essential Medicines –FDCs –Pharmacopoeal monographs –TRIPs-compatible legislation Strategic information –Prequalification project –Sources and prices and pricing studies

26. World Health Organization "3 by 5" Target http://www.who.int/3by5 "3 by 5" Make It Happen For further information………. Peter Graaff graaffp@who.int