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Political Declaration Target 4 - Antiretroviral Treatment Access
Reach 15 million people living with HIV with lifesaving antiretroviral treatment by 2015
Antiretroviral (ARV) treament is estimated to have averted 6.6 million AIDS-related deaths worldwide from 1995 to 2012. The scale-up of treatment is impressive; in December 2012, 10.6 million people were accessing treatment worldwide – reflecting an increase of 1.6 million more people than in 2011. We are therefore nearly two-thirds of the way towards achieving the target of reaching 15 million people.
In July 2013, UNAIDS, WHO, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, tuberculosis (TB) and malaria joined to launch the Treatment 2015 initiative, which aims to ensure that the world reaches its 2015 HIV treatment target. It emphasises speed in scaling up, and focus in key geographic areas and populations.
The new treatment guidelines issued by WHO in 2013, 1 reflect the aims of the Global Fund, regarding the need for the faster scale-up of immediate treatment for specific groups, such as pregnant women and children younger than five.
However, access to ARV treatment is highly variable and often limited, particularly in sub-Saharan Africa. This lack of access often leads to a late diagnosis of HIV, dangerously increasing the risk of HIV-related illness and death. The 9.7 million people in low- and middle-income countries currently accessing treatment only represent 34 percent of the people eligible in 2013. Coverage for children is also very low: in 9 out of 22 priority countries, only 25 percent of eligible children received ARV in 2012. Coverage for adult men is also 16 percent lower than for adult women in most regions.
Global statistics are very difficult to quantify for other vulnerable groups thought to be facing barriers to treatment. However, reports have indicated that men who have sex with men (MSM), injecting drug users (IDUs), sex workers and transgender people are highly likely to face discrimination when seeking treatment, and therefore experience particularly low coverage. Refugees and internally displaced persons face similar obstacles alongside denied basic health care. Young people (or adolescents - those aged between 10 and 19) also face significant gaps in treatment coverage, as they are the only group for which AIDS-related deaths have risen since 2001.
What still needs to be done?
- Increase commitment to scale-up coverage for key populations. Prioritising and specialising treatment plans for key populations, such as young people, is essential to curb new infections and AIDS-related deaths.
- Introduce annual HIV testing in high prevalence areas, such as sub-Saharan Africa; a region where surveys between 2007 and 2011 found that as many as 36 percent of people had never been tested. Of those that had been tested, 25 percent did not know their current status (from an HIV test in the past 12 months). Knowing your current status is essential to prevent onwards transmission to others.
- Develop innovative testing approaches to increase knowledge and early diagnosis. Potential tests include rapid diagnostic tests, which can provide a result in thirty minutes, and can be used by individuals in privacy. A trial in Malawi found that treatment uptake doubled when provided at home, and combined with self-testing. Community-based testing also yields high rates of treatment uptake and can provide screening and prevention for HIV and multiple diseases.
- Continue to analyse the treatment cascade. This enables us to see where people tend to drop out of treatment, showing which areas and groups need to be prioritised for treatment retention and adherence.
- Use Treatment 2.0 as a guideline. This is an approach that aims to promote local HIV treatment and programmes. As reports have consistently demonstrated that strong links between treatment centres and community groups aid treatment adherence, a localised approach could reduce the gaps in treatment coverage.
- Individual countries should explore strategies to diversify funding sources and generate renewable funding. This would reduce dependence on international financing for treatment programmes. Independently importing and manufacturing medicines would reduce the cost of antiretroviral medicines (ARVs).
- Low- and middle-income countries should adopt 2013 WHO guidelines. These include making a simplified, daily single-pill regimen available to patients, in order to make regimens durable.
- Countries should make a strong political commitment to ensure investments. This commitment would increase efforts to ensure ARV supplies and develop early warning systems for ARV stock-outs.
- Introduce regional and global initiatives to regulate ARV quality control, management of intellectual property rights, drug pricing and local production.
- Increase domestic and international contributions to the HIV and AIDS response. This will aid the improvement of efficiency and strengthening community systems, and enable the production of ARVs in Africa.
- Treatment 2015 recommends intensified efforts in 30 countries where nine out of ten people eligible for treatment are not receiving it: Angola, Brazil, China, Cameroon, Central African Republic, Chad, Colombia, Cote d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Indonesia, Kenya, Lesotho, Malawi, Mozambique, Myanmar, Nigeria, Russian Federation, South Africa, South Sudan, Thailand, Togo, Uganda, Ukraine, United Republic of Tanzania, Viet Nam, Zambia and Zimbabwe.
- Increase information sharing and technical support between middle-income countries. It has been projected that the majority of people living with HIV will be living in middle-income countries by 2020. The impact on these countries will be lessened if information on prices and patents is shared, encouraging collaboration and transparency of information.
- 15 out of the 109 countries that identified HIV treatment as a national priority are not on track to achieve the 2015 target.
- The pace of scale-up needs to accelerate if the global target is to be reached.