[afro-nets] Access to HIV Treatment in Developing Countries

[Leela McCullough <leela@healthnet.org>]

Access to HIV Treatment Continues to Accelerate in Developing
Countries
-------------------------------------------------------------

05 July 2005
http://www.whoint.org

The number of people receiving combination antiretroviral ther-
apy (ART) for HIV/AIDS in developing countries is increasing
significantly more than doubling from 400 000 in December 2003
to approximately one million in June 2005 according to a new re-
port released today by the World Health Organization (WHO) and
the Joint United Nations Programme on HIV/AIDS (UNAIDS). How-
ever, access to HIV treatment continues to fall short of the
growing need, and overall progress is unlikely to be fast enough
to reach the target set by WHO and UNAIDS of treating three mil-
lion people by the end of 2005.

The WHO/UNAIDS report shows that the number of people receiving
ART is increasing in every region of the world, and the rate of
scale-up is also accelerating. In sub-Saharan Africa, the region
most severely affected by HIV, approximately 500 000 people are
currently receiving ART more than triple the number of people on
ART in June 2004, and nearly double the number just six months
ago. Similarly, in Asia -- the second most affected region --
the number of people with access to ART has tripled since June
2004 to approximately 155 000 today. More than 50 per cent of
this increase occurred in the first six months of this year.

Today's WHO/UNAIDS report identifies the factors that have
helped some countries to achieve important advances in access to
ART, as well as the bottlenecks that have slowed progress in
many areas. The progress made to date has been possible as a re-
sult of the concerted efforts of many countries and donors with
technical assistance from UNAIDS, WHO and other partners. The
report provides a series of recommendations to increase progress
in treatment scale-up, including adopting simplified and stan-
dardized treatment approaches that can maximize the number of
people receiving quality ART, and help strengthen overall health
systems capacity.

"The movement to expand HIV treatment access is making substan-
tial progress," said WHO Director-General Dr LEE Jong-wook.
"This is the first time that complex therapy for a chronic con-
dition has been introduced at anything approaching this scale in
the developing world. The challenges in providing sustainable
care in resource-poor settings are enormous, as we expected them
to be. But every day demonstrates that this type of care can and
must be provided."

"It is imperative that we continue to speed up access to life-
saving HIV treatment, not only as a means of treating the mil-
lions in need today, but also as a tool to help prevent millions
of additional infections," said UNAIDS Executive Director Dr Pe-
ter Piot. "One of the key findings of the new report is that the
availability of treatment increases the number of people who ac-
cess key prevention services, such as testing and counseling."

The "3 by 5" target, endorsed by all 192 WHO Member States, was
intended as an interim step toward the goal of universal access
to HIV treatment for those who need it. The target was based on
what could be achieved if countries, donors, and international
agencies were fully successful in expanding political will, mo-
bilizing funding resources, and building health infrastructure
and systems. Today's report emphasizes that while political, fi-
nancial, and technical support for ART scale-up have in some
cases met or exceeded expectations, in others the prerequisites
of a successful response are still not fully in place.

Moving Forward to Expand Treatment Access

Progress in scaling up access to ART varies considerably from
country to country. To date, 14 low- and middle-income countries
have met the "3 by 5" target of providing ART to at least half
of the people in need, and several are moving towards providing
universal access. The experiences of many of these countries in-
form the report's recommendations for accelerating progress in
all countries.

In the past 18 months, we've learned a tremendous amount about
scaling up access to HIV treatment in even the poorest settings,
said Dr Jim Yong Kim, Director of WHO's HIV/AIDS Department. Ma-
jor concerns remain including more affordable drug prices and
greater access to new drugs through exercising TRIPS flexibil-
ities. But we've learned beyond any doubt that treatment in the
developing world is feasible, effective, and increasingly af-
fordable. We've also seen in every case that what underpins suc-
cess is an essential combination of political, technical, and
financial support, invested in a way that strengthens overall
capacity to deliver essential health services."

WHO/UNAIDS' recommendations for increasing the pace of ART
scale-up in developing countries include the following:

Political commitment: Of 49 WHO/UNAIDS "focus countries", 40
have established national targets for treatment access, and 34
are developing or have completed implementation plans. These
plans are a first step toward rapidly scaling up ART access. The
WHO/UNAIDS report calls for countries that do not have concrete
plans to put them in place quickly.

Standardized approaches and increased capacity: The countries
making the most significant progress in providing quality ART to
the greatest number of people are those that have adopted stan-
dardized drug regimens and clinical monitoring procedures. These
countries are also addressing bottlenecks in procurement and
supply chain management and in human resources capacity by
training non-physician health workers to safely and effectively
administer ART. More countries should follow these leads.

Technical support: WHO and other UN agencies are in the process
of increasing technical assistance to countries in scaling up
their ART programmes and strengthening their health sectors
overall. A key WHO initiative employs new mapping software to
help countries pinpoint the greatest unmet needs for a range of
health services, in order to best target available resources.
Overall, there is a need for technical assistance agencies to
better coordinate with each other and with donors. The new UN-
AIDS Global Task Team is one forum for promoting this kind of
improved cooperation.

Sustainable financing: Donors have committed a total of US$ 27
billion over the next three years for HIV/AIDS treatment, care,
and prevention efforts. However, not all of these commitments
have been delivered, and the total amount pledged leaves a pro-
jected shortfall of at least US$ 18 billion for the period 2005-
2007. Donors should accelerate funding disbursements to coun-
tries, increase their commitments, and pledge long-term, pre-
dictable funding. Developing countries should continue to invest
their own resources. The new G-8 debt relief proposal provides
an opportunity for several countries to reallocate significant
resources to HIV/AIDS.

Linking treatment and prevention: Evidence is emerging that ART
availability leads to an upsurge in demand for HIV testing and
counseling and other prevention services. In one district in
Uganda, introduction of ART led to a 27-fold increase in demand
for HIV testing and counseling. The WHO/UNAIDS report recommends
steps for countries to integrate HIV treatment with testing and
prevention, including using the same health clinics to offer
both treatment and testing, and training health workers who ad-
minister ART to also offer prevention.

Toward Universal Access to Treatment and Prevention

The "3 by 5" target has been a major catalyst for mobilizing in-
ternational support and action around the global effort to ex-
pand HIV treatment access. The experience gained in providing
treatment to an initial one million people has laid the founda-
tion for an accelerated scale-up in the future toward the goal
of universal access to treatment by 2010, as called for in the
G-8 Finance Ministers' meeting of 10-11 June 2005.

A key challenge in achieving universal access to both treatment
and prevention will be the provision of increased financial and
technical support to strengthen health and social systems. Pri-
orities need to shift to ensuring that essential packages of
prevention, treatment and care services are in place district by
district, and community by community. It is also necessary to
measure progress and analyse barriers to implementation on a
continuous basis in order to inform effective action.

Scaling up HIV treatment presents an opportunity for countries
to make lasting improvements in training health workers and es-
tablishing effective systems for providing a spectrum of health
care to those who need it most. It is also critical to meeting a
number of broader health and development goals. The rapid spread
of HIV and HIV-related illness and death are directly impeding
progress in six of eight key areas addressed by the Millennium
Development Goals, which seek to make dramatic gains in improv-
ing health and reducing poverty worldwide by the middle of the
next decade.

WHO/UNAIDS Estimates of Treatment Access

WHO/UNAIDS ART access estimates reflect a broad range of efforts
to provide HIV treatment in developing countries. ART programmes
are financed and operated in large part by countries themselves,
with the support of a range of bilateral and multinational do-
nors, including the Global Fund to Fight AIDS, Tuberculosis, and
<http://www.medicalnewstoday.com/linkfwd.php?type=kw&link=http:/
/www.patienthealthinternational.com/ncm.aspx?type=article&param=
501638>Malaria (the Global Fund), the U.S. President's Emergency
Plan for AIDS Relief, and other donors, with technical support
provided by a number of international agencies, including WHO
and UNAIDS.

In compiling estimates of ART access, WHO uses the most recent
country reports received from the health ministry, the WHO or
UNAIDS country office, or another reliable source in the coun-
try. These reports are checked against data from major donors,
including the Global Fund and the U.S. President's Emergency
Plan for AIDS Relief. The reports are also checked against data
from the pharmaceutical companies that manufacture ART drugs and
ship them to developing countries.

A comprehensive report and county-specific analysis of access
efforts and obstacles that remain will be released by the end of
2005.

--
Leela McCullough, Ed.D.
Director of Information Services

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