For information/interest.
Paul

Access to HIV treatment continues to accelerate in developing countries,
but bottlenecks persist, says WHO/UNAIDS report

Full report available at:
http://www.who.int/entity/3by5/fullreportJune2005.pdf

The number of people receiving combination antiretroviral therapy (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 report released today by the World
Health Organization (WHO) and the Joint United Nations Programme on
HIV/AIDS (UNAIDS). However, 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
million 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 result 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 standardized 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 substantial
progress,” said WHO Director-General Dr LEE Jong-wook. “This is the
first time that complex therapy for a chronic condition 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 millions in need today,
but also as a tool to help prevent millions of additional infections,”
said UNAIDS Executive Director Dr Peter Piot. “One of the key findings
of the new report is that the availability of treatment increases the
number of people who access 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, mobilizing funding resources, and building
health infrastructure and systems.

Today’s report emphasizes that while political, financial, 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 inform 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. “Major concerns remain
including more affordable drug prices and greater access to new drugs
through exercising TRIPS flexibilities. But we’ve learned beyond any
doubt that treatment in the developing world is feasible, effective, and
increasingly affordable. We’ve also seen in every case that what
underpins success 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 standardized 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 UNAIDS 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 projected shortfall of at least US$ 18
billion for the period 2005-2007. Donors should accelerate funding
disbursements to countries, increase their commitments, and pledge
long-term, predictable 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 administer ART to also offer prevention.

Toward Universal Access to Treatment and Prevention

The "3 by 5" target has been a major catalyst for mobilizing
international support and action around the global effort to expand HIV
treatment access. The experience gained in providing treatment to an
initial one million people has laid the foundation 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. Priorities 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 establishing
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 improving 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 donors, including the
Global Fund to Fight AIDS, Tuberculosis, and 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 country. 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.


-- 
Professor Paul Bywaters
Director, Centre for Social Justice
Coventry University
Priory Street
Coventry CV1 5FB

Phone: 02476 795841