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Adoption of the 2015 World Health Organization guidelines on antiretroviral therapy: Programmatic implications for India.
WHO South - East Asia Journal of Public Health. 2017 Apr; 6(1):90-93.The therapeutic and preventive benefits of early initiation of antiretroviral therapy (ART) for HIV are now well established. Reflecting new research evidence, in 2015 the World Health Organization (WHO) recommended initiation of ART for all people living with HIV (PLHIV), irrespective of their clinical staging and CD4 cell count. The National AIDS Control Programme (NACP) in India is currently following the 2010 WHO ART guidelines for adults and the 2013 guidelines for pregnant women and children. This desk study assessed the number of people living with HIV who will additionally be eligible for ART on adoption of the 2015 WHO recommendations on ART. Data routinely recorded for all PLHIV registered under the NACP up to 31 December 2015 were analysed. Of the 250 865 individuals recorded in pre-ART care, an estimated 135 593 would be eligible under the WHO 2013 guidelines. A further 100 221 would be eligible under the WHO 2015 guidelines. Initiating treatment for all PLHIV in pre-ART care would raise the number on ART from 0.92 million to 1.17 million. In addition, nearly 0.07 million newly registered PLHIV will become eligible every year if the WHO 2015 guidelines are adopted, of which 0.028 million would be attributable to implementation of the WHO 2013 guidelines alone. In addition to drugs, there will be a need for additional CD4 tests and tests of viral load, as the numbers on ART will increase significantly. The outlay should be seen in the context of potential health-care savings due to early initiation of ART, in terms of the effect on disease progression, complications, deaths and new infections. While desirable, adoption of the new guidance will have significant programmatic and resource implications for India. The programme needs to plan and strengthen the service-delivery mechanism, with emphasis on newer and innovative approaches before implementation of these guidelines.
National responses to global health targets: exploring policy transfer in the context of the UNAIDS '90-90-90' treatment targets in Ghana and Uganda.
Health Policy and Planning. 2018 Jan 1; 33(1):17-33.Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, program and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Program on HIV/AIDS set ‘ambitious’ treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by program, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to ‘90-90-90’. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in program-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90-90-90. Interviews were transcribed and analyzed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh’s policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90-90-90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of program activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation, facilitating a shift in the HIV program from ‘business as usual’ to approaches targeting geographies and populations.
Geneva, Switzerland, UNAIDS, 2017. 198 p. (UNAIDS/JC2900E)Since they were launched at the 20th International AIDS Conference in Melbourne, Australia, in 2014, the 90-90-90 targets have become a central pillar of the global quest to end the AIDS epidemic. The targets reflect a fundamental shift in the world’s approach to HIV treatment, moving it away from a focus on the number of people accessing antiretroviral therapy and towards the importance of maximising viral suppression among people living with HIV. This shift was driven by greater understanding of the benefits of viral suppression -- not only does treatment protect people living with HIV from AIDS-related illness, but it also greatly lowers the risk of transmitting the virus to others.
Southern African Journal of HIV Medicine. 2016; 17(1): p.Background: The World Health Organization (WHO) HIV treatment guidelines have been used by various countries to revise their national guidelines. Our study discusses the national policy response to the HIV epidemic in sub-Saharan Africa and quantifies delays in adopting the WHO guidelines published in 2009, 2013 and 2015. Methods: From the Internet, health authorities and experts, and community members, we collected 59 published HIV guidelines from 33 countries in the sub-Saharan African region, and abstracted dates of publication and antiretroviral therapy (ART) eligibility criteria. For these 33 countries, representing 97% regional HIV burden in 2015, the number of months taken to adopt the WHO 2009, 2013 and/or 2015 guidelines were calculated to determine the average delay in months needed to publish revised national guidelines. Findings: Of the 33 countries, 3 (6% regional burden) are recommending ART according to the WHO 2015 guidelines (irrespective of CD4 count); 19 (65% regional burden) are recommending ART according to the WHO 2013 guidelines (CD4 count = 500 cells/mm3); and 11 (26% regional burden) according to the WHO 2009 guidelines (CD4 count = 350 cells/mm3). The average time lag to WHO 2009 guidelines adoption in 33 countries was 24 (range 3–56) months. The 22 that have adopted the WHO 2013 guidelines took an average of 10 (range 0–36) months, whilst the three countries that adopted the WHO 2015 guidelines took an average of 8 (range 7–9) months. Conclusion: There is an urgent need to shorten the time lag in adopting and implementing the new WHO guidelines recommending ‘treatment for all’ to achieve the 90-90-90 targets.
Geneva, Switzerland, UNAIDS, 2016.  p.This report highlights best practices and provides examples of countries that are already coming close to achieving the 90–90–90 targets, which are that 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads. The report outlines steps that are needed to expedite gains towards each of the three 90s. Technological and service delivery innovations rapidly need to be brought to scale, communities must be empowered to lead the push to end the epidemic, new resources must be mobilized to reach the final mile of the response to HIV and steps must urgently be taken to eliminate social and structural barriers to service access.
Indian Pediatrics. 2015 Apr; 52(4):293-5.Add to my documents.
HIV treatment as prevention: how scientific discovery occurred and translated rapidly into policy for the global response.
Health Affairs. 2012 Jul; 31(7):1439-49.In 2011 interim results of HIV Prevention Trials Network study 052, a National Institutes of Health study designed to test the effectiveness of antiretroviral treatment against the spread of HIV, were reported. These results showed that in a stable relationship in which one member of the couple was infected with HIV, treatment of the infected partner with antiretroviral drugs, combined with couples counseling and condom use, resulted in a 96 percent reduction in sexual transmission of HIV-1. This finding led to the use of antiretroviral treatment as a cornerstone of HIV prevention. Independent advisory committees of the President's Emergency Plan for AIDS Relief (PEPFAR) and the World Health Organization (WHO) have since issued analyses that set the stage for broader use of antiretroviral agents in treatment and prevention. This article describes the separate PEPFAR and WHO recommendations and outlines the design of prospective new trials to test how best to maximize the benefits of early treatment for prevention.
Challenges and priorities in the management of HIV/HBV and HIV/HCV coinfection in resource-limited settings.
Seminars In Liver Disease. 2012 May; 32(2):147-57.Liver disease due to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is now emerging as an increasing cause of morbidity and mortality in human immunodeficiency virus- (HIV-) infected persons in resource-limited settings (RLS). Existing management guidelines have generally focused on care in tertiary level facilities in developed countries. Less than half of low-income countries have guidance, and in those that do, there are important omissions or disparities in recommendations. There are multiple challenges to delivery of effective hepatitis care in RLS, but the most important remains the limited access to antiviral drugs and diagnostic tests. In 2010, the World Health Assembly adopted a resolution calling for a comprehensive approach for the prevention, control, and management of viral hepatitis. We describe activities at the World Health Organization (WHO) in three key areas: the establishment of a global hepatitis Program and interim strategy; steps toward the development of global guidance on management of coinfection for RLS; and the WHO prequalification program of HBV and HCV diagnostic assays. We highlight key research gaps and the importance of applying the lessons learned from the public health scale-up of ART to hepatitis care. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Bangkok, Thailand, UNAIDS, Regional Support for Asia and the Pacific, 2011.  p. (UNAIDS / 11.05E)This report provides the most up to date information on the HIV epidemic in the region in 2011. While the region has seen impressive gains -- including a 20% drop in new HIV infections since 2001 and a three-fold increase in access to antiretroviral therapy since 2006 -- progress is threatened by an inadequate focus on key populations at higher risk of HIV infection and insufficient funding from both domestic and international sources.
Journal of Health Care Finance. 2010; 36(4):75-79.When the United Nations declared "health care for all" (at the conferences at Alma-Ata in 1978 and the Ottawa Charter in 1986),(1) the declarations were largely premature to impact the upcoming HIV/AIDS epidemic. These UN declarations still apply today, as multitudes of humanity continue to die from what amounts now to be a treatable chronic disease. Can the wealthier, industrialized countries stand by and watch the decimation of the populations of the developing world by HIV / AIDS? The global "health 9/10 gap," relates that only 10 percent of global heath resources go to developing countries - i.e., those having 90 percent of the poorest world populations. (2) The World Bank/World Health Organization has been at the forefront of providing resources for the global HIV/AIDS epidemic, (3) but for many countries of the developing world (especially Sub-Saharan Africa) it may be too little, too late. This work explores the application of an ecological model to global policy against HIV/AIDS, highlighting access to antiretroviral drugs (ARV). ARV distribution is constrained by patents and laws protecting the intellectual property rights of the international pharmaceutical corporations. In response to this situation, more questions arise. Will governments in the developing world invoke compulsory licensing (patent-breaking) in their negotiations with the international pharmaceutical corporations to provide medications against HIV/AIDS in their countries? Can international political and financial negotiations with these pharmaceutical corporations speed the growing push for a solution to this solvable crisis? The answers may lie in the "Brazilian model," that is a developing world government using all means available to provide ARV drugs for all its citizens with HIV/AIDS. The basis of this model includes negotiating with the pharmaceutical corporations over patent rights and importation of copied drugs from the Far East.
Arlington, Virginia, John Snow [JSI], AIDS Support and Technical Assistance Resources [AIDSTAR-One], 2009 Mar. 23 p. (USAID Contract No. GHH-I-00-07-00059-00; AIDSTAR-One Technical Brief)This brief describes WHO recommendations and provides links to useful resources for HIV / AIDS program implementers.
A practical guide to integrating reproductive health and HIV / AIDS into grant proposals to the Global Fund.
[Washington, D.C.], Population Action International, 2009 Sep. 61 p.Starting in recent proposal rounds, The Global Fund for AIDS, Tuberculosis and Malaria (GFATM) has stated more explicitly that countries can include reproductive health as part of their proposals on AIDS, tuberculosis and malaria, as long as a justification is provided on the impact of reproductive health (RH) on reducing one of the three diseases. This document is for countries and organizations, including CCMs, government and nongovernmental organizations and civil society organizations, to help in integrating reproductive health, including family planning (RH) and HIV / AIDS in proposals submitted to the Global Fund. The document takes a country approach to integration since the Global Fund seeks to support proposals that build on and strengthen national programs. (Excerpt)
Current Opinion In HIV and AIDS. 2009 May; 4(3):222-31.PURPOSE OF REVIEW: We review the current literature supporting adoption of higher CD4 thresholds for initiation of antiretroviral treatment and survey progress in adoption of early treatment policies in resource-limited settings. We highlight some of the challenges and opportunities implementation of early treatment will bring. RECENT FINDINGS: The initial success of combination antiretroviral treatment resulted in the recommendation to treat early all individuals with HIV. However, the gradual realization that antiretroviral treatment was associated with toxicity led to a more tempered approach. Recent cohort studies and some clinical trials have shown that delaying treatment is associated with increased morbidity and mortality. SUMMARY: Early treatment is routinely practiced in developed countries. Now, early treatment is being adopted as a strategy in many resource-limited settings. The implications of this policy shift are not known, but we predict early treatment will have important consequences for the health system, the individual, and the community. Whereas these consequences will bring significant challenges, the increased numbers of HIV-infected individuals on treatment will result in many new opportunities - antiretroviral treatment will become less expensive, systems to deliver chronic care will be strengthened, and the policy shift will focus greater attention on pregnant women and children. Finally, some authors postulate that early treatment may impact HIV transmission.
Teddington, United Kingdom, Tearfund, 2008 Jul. 44 p.This report provides an overview of PMTCT and is an attempt to explore what is working, and why, in scaling up access. The report captures innovative examples of successful programming and partnerships, while identifying challenges and bottlenecks that must be overcome if these countries are to meet their nationally set universal access targets by 2010. The research methodology used for this report was based on a desk review, interviews with key global informants (see Acknowledgements) and country case studies in Malawi, Nigeria and Zambia in early 2008. The in-country study included semi-structured interviews with representatives of government and nongovernmental organisations as well as focus group discussions with community representatives, participatory and observational methodologies. The main objectives of the research were to: 1) identify and conduct interviews with the key international and national stakeholders and explore the structure, components, implementation, co-ordination, financing, policies, and guidelines and monitoring system of the PMTCT programmes; 2) determine what was working well and why; and 3) identify specific bottlenecks, challenges and recommendations for progress. This report provides an overview of the perceptions of key experts and communities on PMTCT interventions and approaches, current global action and country progress.
Lancet Infectious Diseases. 2008 Feb; 8(2):98-100.Kevin De Cock is director of WHO's HIV/AIDS department. Formerly director of the US Centers for Disease Control and Prevention in Kenya, he is an infectious disease specialist, with expertise in HIV/ AIDS, tuberculosis, liver disease, and tropical diseases such as yellow fever and viral haemorrhagic fevers. TLID: How has your time as WHO's HIV/AIDS director been? KDC: It has been extremely interesting. AIDS policy is always challenging and changing. WHO's HIV efforts up to 2005 were very much oriented around the 3 by 5 initiative. The G8 in 2005 made an announcement about working towards universal access, which became an AIDS rallying cry. So we've had to reorganise ourselves around that as a theme. Some internal reorganisation was necessary to focus not only on treatment, but also on broader issues. We now have five key strategic directions: increasing access to HIV testing and counselling, maximising prevention, accelerating treatment scale-up, strengthening health systems, and investing in strategic information. We have also been working on some important technical areas. One is the issuing of guidance on both provider-initiated testing and male circumcision. In April, 2007, we also issued a report, in response to a request from the World Health Assembly, on the health sector's progress towards universal access. (excerpt)
Lancet. 2007 Jul 7; 370(9581):15-16.A new spirit of cooperation and coordination between the key global players in the fight against HIV/AIDS was cemented at a meeting for programme implementers in Kigali, Rwanda, in mid-June. The partnership comes amidst concerns about rising infection rates in some countries where infections had slowed, as well as worries about the unpredictability of funding for HIV/AIDS activities. The collaboration is expected to curb duplication of efforts and wastage of resources, and to ultimately scale-up AIDS prevention and treatment. The meeting-usually an annual gathering for the US President's Emergency Plan for AIDS Relief (PEPFAR) and its grantees-opened up for the first time to include the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, the World Bank, UNICEF, WHO, and the Global Network of People Living with HIV/AIDS (GNP+), who were all co-sponsors of the conference. (excerpt)
AIDS. 2006 Mar 21; 20(5):653-656.On 1 December 2003, when pilot projects had shown the feasibility of antiretroviral therapy (ART) in the poorest regions of the world, and the prices of antiretroviral drugs had steeply decreased, the World Health Organization (WHO) launched its '3 by 5' initiative, aiming to provide ART to 3 million people by the end of 2005. WHO described the large-scale provision of ART as 'a global health emergency [for which] urgent action is needed'. In June 2005, '3 by 5' released an interim report documenting the impressive progress made, but acknowledging its pace is slower than originally anticipated. However, although the AIDS epidemic in sub-Saharan Africa certainly requires an emergency response with short-term plans and objectives, we argue that the short time horizon risks constricting our insights and that a much longer-term view is now necessary in view of the ultimate goal of universal access to ART. (excerpt)
American Journal of Public Health. 2005 Jul; 95(7):1173-1180.The availability of limited funds from international agencies for the purchase of antiretroviral (ARV) treatment in developing countries presents challenges, especially in prioritizing who should receive therapy. Public input and the protection of human rights are crucial in making treatment programs equitable and accountable. By examining historical precedents of resource allocation, we aim to provoke and inform debate about current ARV programs. Through a critical review of the published literature, we evaluate 4 precedents for key lessons: the discovery of insulin for diabetes in 1922, the release of penicillin for civilian use in 1943, the development of chronic hemodialysis programs in 1961, and current allocation of liver transplants. We then describe current rationing mechanisms for ARVs. (author's)
Tropical Medicine and International Health. 2005 Apr; 10(4):300-304.In scaling up antiretroviral treatment (ART), financing is fast becoming less of a constraint than the human resources to ensure the implementation of the programmes. In the countries hardest affected by the acquired immunodeficiency syndrome (AIDS) pandemic, AIDS increases workloads, professional frustration and burn-out. It affects health workers also directly, contributing to rising sick leave and attrition rates. This burden is shouldered by a health workforce weakened already by chronic deficiencies in training, distribution and retention. In these countries, health workforce issues can no longer be analysed from the traditional perspective of human resource development, but should start from the position that entire societies are in a process of social involution of a scale unprecedented in human history. Strategies that proved to be effective and correct in past conditions need be reviewed, particularly in the domains of human resource management and policy-making, education and international aid. True paradigm shifts are thus required, without which the fundamental changes required to effectively strengthen the health workforce are unlikely to be initiated. (author's)
Geneva, Switzerland, UNAIDS, 2003. Prepared for the 2nd Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 25-27, 2003. 3 p.Over 20 years ago, policy and programmatic approaches to HIV testing emerged in a context of great fear about HIV/AIDS and about how to prevent HIV infected individuals from transmitting the virus. As testing methods were developed, HIV testing assumed an important role in epidemiological surveillance, and as treatment became available, on individual testing for clinical purposes. Yet, as national responses to the emerging epidemics unfolded, numerous States argued that the protection of public health warranted compulsory testing requirements of certain populations considered to be “high risk”, mandatory testing for access to certain goods and services, named reporting of those found to be infected and sometimes contact tracing and mandatory notification of partners, family, employers or community members. The realities of stigma, discrimination and the neglect of human rights protections were recognized to keep people away from prevention and care, and creating fertile ground for people not to get tested and, unaware of their HIV status, to further spread the virus. This recognition lead to a bridge between those concerned with human rights protections and those concerned with public health imperatives. Over time, the components of supportive testing became clearer, the concept of voluntary counseling and testing (VCT) was promulgated and policy direction from GPA/WHO centered on making voluntary counseling and testing an important focus of all national responses to the HIV/AIDS epidemics. This policy, further elaborated by WHO and UNAIDS remains in place today. (excerpt)
Geneva, Switzerland, WHO, 2004. 6 p.WHO and UNAIDS are actively promoting the scale-up of programmes to deliver antiretroviral therapy (ART), with the aim of reaching three million people by the end of 2005 ('3 by 5 Initiative'). Equity in access to HIV treatment is a critical element of the '3 by 5' and will contribute to the broader 'right to health' for all. Attention must therefore be given to ensuring access to ART and other treatment, care and prevention, for people who risk exclusion including on the basis of their sex. Currently there is limited information available on the sex and age distribution of those receiving ART, however, we know that gender-based inequalities often affect women's ability to access services. Attention is therefore required to ensure that women and girls have equitable access to ART as it becomes available. Gender-based inequalities put women and girls at increased risk of acquiring HIV. Women's limited ability to negotiate safer sex practices with their partners, including condom use, can place even women who are faithful to one partner at risk of HIV infection. Married adolescent girls may be particularly vulnerable. Sexual violence, including rape, likewise increases the risk of HIV for women and girls. In addition, they typically have less access to education, income-generating opportunities, property ownership and legal protection than men. This means many women are not able to leave relationships even when they know that they may be at risk of HIV. (excerpt)
From a vicious circle to a virtuous circle: reinforcing strategies of risk, vulnerability, and impact reduction for HIV prevention.
Lancet. 2004 Nov 27; 364:1915-1916.UNAIDS supports the consensus statement on HIV prevention because reducing individual risk is essential to people protecting themselves and others against sexually transmitted HIV infection. Nevertheless, we believe that it is equally critical to mount broad strategies that address vulnerability to HIV exposure—ie, the inability of individuals to control their risk of infection because of contextual factors that create situations of risk. Young people aged 15–24 years constitute half of all new cases of HIV infection worldwide, and need access to the full range of prevention services, information, and commodities. Decreasing their vulnerability to HIV means providing educational opportunities and tackling unemployment and underemployment through job creation and job-training initiatives. Women and girls constitute almost half of all those living with HIV globally. Situations of vulnerability that increase their risk of HIV exposure include unequal access to education, limited employment opportunities, economic dependence, lack of property and inheritance rights, exposure to physical and sexual violence and early marriage. Protecting young people and women from exploitation, trafficking, and sexual abuse is also HIV prevention. (excerpt)
BMJ. British Medical Journal. 2004 Jul 17; 329:121-122.In July 2004 the international community will convene in Bangkok, Thailand, for the 15th international AIDS conference. The gathering occurs at an opportune time in global health as just months earlier, the World Health Organization and UNAIDS launched the "3 by 5" programme--a global initiative to provide antiretroviral therapy to 3 million with HIV/AIDS in developing countries by the end of 2005. Additionally in the past few years the Global Fund to Fight AIDS, Tuberculosis, and Malaria was created, to finance a scaling up of resources for interventions against all three diseases (www.theglobalfund.org/en/). These initiatives are augmented by increases in funding from private, national, and international sources. Together these efforts represent one of the most important trends in global health over the past five years. The movement for increased funding for HIV/AIDS in developing countries has brought attention to the issue and initiated a process of responding to it. Focusing on prevention of HIV and on expanding access to antiretroviral treatment for people living with AIDS is critically important to the fight against HIV/AIDS, but alone this strategy is not enough to tackle the problem. Combating HIV/AIDS in low and middle income countries requires more than prevention and treatment--important as this two pronged strategy is. (excerpt)
Implementing GIPA: how USAID missions and their implementing partners in five Asian countries are fostering greater involvement of people living with HIV / AIDS.
Washington, D.C., Futures Group International, POLICY Project, 2004 Jan.  p. (USAID Contract No. HRN-C-00-00-00006-00)On behalf of the Asia/Near East Bureau (ANE) of the U.S. Agency for International Development (USAID), the POLICY Project undertook an assessment of how the Greater Involvement of People Living with HIV/AIDS (GIPA) Principle is being implemented in the ANE region. Five USAID Missions and 12 implementing agencies (IAs) in the region participated in the assessment, which was undertaken in May and June 2003 in Cambodia, India, Nepal, Philippines, and Viet Nam. The purpose of the assessment was to ascertain how Missions, IAs, and NGOs are incorporating GIPA principles into their organizations and into the programmatic work they support and implement. A self-administered questionnaire was completed by 23 respondents from Missions, IAs, and NGOs. The assessment found a high level of awareness of GIPA and a commitment by most organizations to foster and promote GIPA principles, within their organizations and in the work they carry out. Ninety-one percent of respondents from the three types of organizations believe that their organizations’ planning, programs, and policymaking activities are or would be enhanced by GIPA. (excerpt)
Central European Journal of Public Health. 2004 Mar; 12(1):52.Health workers' experience shows that HAART can be delivered and is effective in poor settings. The World Health Organization (WHO) welcomes the research published in the issue of The Lancet highlighting the substantial increased survival for people with HIV/AIDS who have access to highly active antiretroviral therapy (HAART). The new report focuses on findings in rich countries, but the experience of WHO and public health workers in clinics around the world shows that antiretroviral therapy (ART) can be delivered effectively and with equally dramatic results in poor countries. This research and the new evidence that antiretroviral therapy is extremely effective gives added backing to WHO in its push to deliver antiretrovirals to three million people in developing countries by the end of 2005 (the "3 by 5" target). WHO expects survival gains to be as good or even better in resource-poor settings over a similar period of time. "Treatment with antiretrovirals works for everyone - rich and poor. Now the poor urgently need access to these drug," said Dr Charlie Gilks, head of WHO's "3 by 5" team. "We are determined too simplify treatments and to ensure that affordable, quality drugs reach those in need as quickly as possible." (excerpt)