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The continuum of HIV care in South Africa: implications for achieving the second and third UNAIDS 90-90-90 targets.
AIDS. 2017 Feb 20; 31(4):545-552.BACKGROUND: We characterize engagement with HIV care in South Africa in 2012 to identify areas for improvement towards achieving global 90-90-90 targets. METHODS: Over 3.9 million CD4 cell count and 2.7 million viral load measurements reported in 2012 in the public sector were extracted from the national laboratory electronic database. The number of persons living with HIV (PLHIV), number and proportion in HIV care, on antiretroviral therapy (ART) and with viral suppression (viral load <400 copies/ml) were estimated and stratified by sex and age group. Modified Poisson regression approach was used to examine associations between sex, age group and viral suppression among persons on ART. RESULTS: We estimate that among 6511 000 PLHIV in South Africa in 2012, 3300 000 individuals (50.7%) accessed care and 32.9% received ART. Although viral suppression was 73.7% among the treated population in 2012, the overall percentage of persons with viral suppression among all PLHIV was 23.8%. Linkage to HIV care was lower among men (38.5%) than among women (57.2%). Overall, 47.1% of those aged 0-14 years and 47.0% of those aged 15-49 years were linked to care compared with 56.2% among those aged above 50 years. CONCLUSION: Around a quarter of all PLHIV have achieved viral suppression in South Africa. Men and younger persons have poorer linkage to HIV care. Expanding HIV testing, strengthening prompt linkage to care and further expansion of ART are needed for South Africa to reach the 90-90-90 target. Focus on these areas will reduce the transmission of new HIV infections and mortality in the general population.
Lancet. Psychiatry. 2015 Jun; 2(6):487-8.Add to my documents.
Geneva, Switzerland, UNAIDS, Joint United Nations Programme on HIV/AIDS, 2014 Oct. 40 p.In December 2013, the UNAIDS Programme Coordinating Board called on UNAIDS to support country- and region-led efforts to establish new targets for HIV treatment scale-up beyond 2015. In response, stakeholder consultations on new targets have been held in all regions of the world. At the global level, stakeholders assembled in a variety of thematic consultations focused on civil society, laboratory medicine, paediatric HIV treatment, adolescents and other key issues. The 90-90-90 UNAIDS target seeks to: 1) By 2020, 90% of all people living with HIV will know their HIV status; 2) By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 3) By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression. Key points: 1) Governments, health experts and civil society must take advantage of the next five-year window to meet the 90-90-90 target to tackle AIDS; 2) Early treatment can reduce infection rates by 90 %; 3) A paradigm shift in HIV/AIDS treatment has seen average drug prices fall from an average of US$15 000 to US$ 80; and 4) Health systems will improve as a result of investment in HIV/AIDS treatment; financing from the international community is indispensable.
Global Public Health. 2016 Aug 6; 1-15.The drive for universal health coverage (UHC) now has a great deal of normative impetus, and in combination with the inauguration of the sustainable development goals, has come to be regarded as a means of ensuring the financial basis for the struggle against HIV and AIDS. The argument of this paper is that such thinking is a case of ‘the right thing at the wrong time’: it seriously underestimates the scale of the work against HIV and AIDS, and the speed with which we need to undertake it, if we are to consolidate the gains we have made to date, let alone reduce it to manageable proportions. The looming ‘fiscal crunch’ makes the challenges all the more daunting; even in the best circumstances, the time required to establish UHCs capable of providing both essential health services and a very rapid scale-up of the fight against HIV and AIDS is insufficient when set against the urgency of ensuring that AIDS does not eventuate as a global health catastrophe.
[New York, New York], United Nations General Assembly, 2016 Apr 1.  p. (A/70/811)This new report warns that the AIDS epidemic could be prolonged indefinitely if urgent action is not implemented within the next five years. The report reveals that the extraordinary acceleration of progress made over the past 15 years could be lost and urges all partners to concentrate their efforts to increase and front-load investments to ensure that the global AIDS epidemic is ended as a public health threat by 2030. The review of progress looks at the gains made, particularly since the 2011 United Nations Political Declaration on HIV and AIDS, which accelerated action by uniting the world around a set of ambitious targets for 2015. The report outlines that the rapid treatment scale-up has been a major contributing factor to the 42% decline in AIDS-related deaths since the peak in 2004 and notes that this has caused life expectancy in the countries most affected by HIV to rise sharply in recent years. The report underlines the critical role civil society has played in securing many of the gains made and the leadership provided by people living with HIV. Community efforts have been key to removing many of the obstacles faced in scaling up the AIDS response, including reaching people at risk of HIV infection with HIV services, helping people to adhere to treatment and reinforcing other essential health services.
Geneva, Switzerland, UNAIDS, 2015.  p.This document, released on the World AIDS Day 2015, provides an update on the global status of the HIV epidemic. According to the press release, the epidemic has been forced into decline. New HIV infections and AIDS-related deaths have fallen dramatically since the peak of the epidemic. The document cites a 35 percent decrease in new HIV infections; a 42 percent decrease in AIDS-related deaths since the peak in 2004; a 58 percent decrease in new HIV infections among children since 2000; and an 84 percent increase in access to antiretroviral therapy since 2010. Additionally, the global response to HIV has averted 30 million new HIV infections and 7.8 million AIDS-related deaths since 2000. While acknowledging these achievements, the report also emphasizes that accelerating the AIDS response in low-and middle-income countries could avert 28 million new HIV infections and 21 million AIDS-related deaths between 2015 and 2030, saving US$24 billion annually in additional HIV treatment costs. The next phase of the global response must accommodate new circumstances, opportunities, and evidence, including a rapidly shifting context and a new, sustainable development agenda. The single priority of the HIV response for the next 15 years is to end the epidemic by 2030.
Antiviral therapy. 2014; 19 Suppl 3:1.Add to my documents.
Simplification of antiretroviral therapy: a necessary step in the public health response to HIV/AIDS in resource-limited settings.
Antiviral therapy. 2014; 19 Suppl 3:31-7.The global scale-up of antiretroviral therapy (ART) over the past decade represents one of the great public health and human rights achievements of recent times. Moving from an individualized treatment approach to a simplified and standardized public health approach has been critical to ART scale-up, simplifying both prescribing practices and supply chain management. In terms of the latter, the risk of stock-outs can be reduced and simplified prescribing practices support task shifting of care to nursing and other non-physician clinicians; this strategy is critical to increase access to ART care in settings where physicians are limited in number. In order to support such simplification, successive World Health Organization guidelines for ART in resource-limited settings have aimed to reduce the number of recommended options for first-line ART in such settings. Future drug and regimen choices for resource-limited settings will likely be guided by the same principles that have led to the recommendation of a single preferred regimen and will favour drugs that have the following characteristics: minimal risk of failure, efficacy and tolerability, robustness and forgiveness, no overlapping resistance in treatment sequencing, convenience, affordability, and compatibility with anti-TB and anti-hepatitis treatments.
Geneva, Switzerland, UNAIDS, 2014.  p. (Reference)It is essential that all people, including people living with HIV, are able to access health services and ongoing treatment. If people living with HIV who are on ART stop abruptly because they cannot access new supplies they could rapidly become unwell, drug resistance may build and the chances of onward transmission of the virus would increase. UNAIDS is working to mitigate the impact the EVD outbreak is having on access to treatment and care for people living with HIV and on new patient enrolment. In order to provide continuity of treatment to people on ART, community networks, supported by UNAIDS have been working with the National AIDS Councils to establish additional service delivery points. People on ART have been collecting their medicines from the offices of the National AIDS Councils and wherever possible, patients have been given supplies for longer periods than usual. UNAIDS is fully supporting United Nations Mission for Ebola Emergency Response (UNMEER) and the five pillar framework. UNAIDS country offices in each of the three countries, as well as the Regional Support Team in Dakar, are contributing to the Ebola operations centres, the national Ebola task forces or committees, the presidential Ebola task forces and other coordination mechanisms. (Excerpts)
Geneva, Switzerland, UNAIDS, 2014 Jul.  p. (UNAIDS / JC2656)How do we close the gap between the people moving forward and the people being left behind? This was the question we set out to answer in the UNAIDS Gap report. Similar to the Global report, the goal of the Gap report is to provide the best possible data, but, in addition, to give information and analysis on the people being left behind. A new report by UNAIDS shows that 19 million of the 35 million people living with HIV globally do not know their HIV-positive status. The UNAIDS Gap report shows that as people find out their HIV-positive status they will seek life-saving treatment. In sub-Saharan Africa, almost 90% of people who tested positive for HIV went on to access antiretroviral therapy (ART). Research shows that in sub-Saharan Africa, 76% of people on ART have achieved viral suppression, whereby they are unlikely to transmit the virus to their sexual partners. New data analysis demonstrates that for every 10% increase in treatment coverage there is a 1% decline in the percentage of new infections among people living with HIV. The report highlights that efforts to increase access to ART are working. In 2013, an additional 2.3 million people gained access to the life-saving medicines. This brings the global number of people accessing ART to nearly 13 million by the end of 2013. Based on past scale-up, UNAIDS projects that as of July 2014 as many as 13 950 296 people were accessing ART. By ending the epidemic by 2030, the world would avert 18 million new HIV infections and 11.2 million AIDS-related deaths between 2013 and 2030.
Geneva, Switzerland, WHO, 2014 Jul.  p.In this new consolidated guidelines document on HIV prevention, diagnosis, treatment and care for key populations, the World Health Organization brings together all existing guidance relevant to five key populations -- men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people --and updates selected guidance and recommendations. These guidelines aim to: provide a comprehensive package of evidence-based HIV-related recommendations for all key populations; increase awareness of the needs of and issues important to key populations; improve access, coverage and uptake of effective and acceptable services; and catalyze greater national and global commitment to adequate funding and services.
Ten targets: 2011 United Nations General Assembly Political Declaration on HIV / AIDS: Targets and elimination commitments.
Geneva, Switzerland, UNAIDS, 2011.  p.Ten targets in the campaign to achieve universal access to HIV prevention, treatment, care and support by 2015 are listed. Targets include: Reduce sexual transmission of HIV by 50% by 2015; Reduce transmission of HIV among people who inject drugs by 50% by 2015; Eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths; Reach 15 million people living with HIV with lifesaving antiretroviral treatment by 2015; Reduce tuberculosis deaths in people living with HIV by 50 percent by 2015; Close the global AIDS resource gap by 2015 and reach annual global investment of US$22-24 billion in low- and middle-income countries; Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV; Eliminate stigma and discrimination against people living with and affected by HIV through promotion of laws and policies that ensure the full realization of all human rights and fundamental freedoms; Eliminate HIV-related restrictions on entry, stay and residence; Eliminate parallel systems for HIV-related services to strengthen integration of the AIDS response in global health and development efforts.
Geneva, Switzerland, UNAIDS, 2011.  p.A new report by the Joint United Nations Programme on HIV / AIDS (UNAIDS), released on 21 November, shows that 2011 was a game changing year for the AIDS response with unprecedented progress in science, political leadership and results. The report also shows that new HIV infections and AIDS-related deaths have fallen to the lowest levels since the peak of the epidemic.
Geneva, Switzerland, UNAIDS, 2011.  p.The data tables describe in greater detail the progress being made against the HIV epidemic and the main challenges to achieving zero HIV infections and zero AIDS deaths. The data are drawn from country progress reports and will be updated regularly. This document reflects information found in the publication “Global HIV / AIDS response: epidemic update and health sector progress towards universal access: progress report 2011", by UNAIDS, UNICEF and WHO.
Geneva, Switzerland, UNAIDS, 2010 Dec.  p. (UNAIDS/10.12E/JC2034E)This Strategy has been developed through wide consultation, informed by the best evidence and driven by a moral imperative to achieve universal access to HIV prevention, treatment, care and support and the Millennium Development Goals.
Geneva, Switzerland, UNAIDS, 2010.  p. (UNAIDS/10.11E ; JC1958E)The 2010 edition of the UNAIDS Report on the global AIDS epidemic includes new country by country scorecards on key issues facing the AIDS response. Based on the latest data from 182 countries, this global reference book provides comprehensive analysis on the AIDS epidemic and response. For the first time the report includes trend data on incidence from more than 60 countries.
Geneva, Switzerland, UNAIDS, 2011.  p.30 years into the AIDS epidemic, 30 milestones, thoughts, images, words, artworks, breakthroughs, inspirations, and ideas in response.
Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive. 2011-2015.
Geneva, Switzerland, UNAIDS, 2011.  p. (UNAIDS/ JC2137E)This Global Plan provides the foundation for country-led movement towards the elimination of new HIV infections among children and keeping their mothers alive. The Global Plan was developed through a consultative process by a high level Global Task Team convened by UNAIDS. It brought together 25 countries and 30 civil society, private sector, networks of people living with HIV and international organizations to chart a roadmap to achieving this goal by 2015.
Geneva, Switzerland, WHO, 2011.  p.In June 2010, the UNAIDS Secretariat and WHO launched Treatment 2.0, an initiative designed to achieve and sustain universal access and maximize the preventive benefits of antiretroviral therapy (ART). Treatment 2.0 builds on '3 by 5' and the programmatic and clinical evidence and experience over the last 10 years to expand access to HIV diagnosis, treatment and care through a series of innovations in five priority work areas: drugs, diagnostics, costs, service delivery and community mobilization. The principles and priorities of Treatment 2.0 address the need for innovation and efficiency gains in HIV programmes, in greater effectiveness, intervention coverage and impact in terms of both HIV-specific and broader health outcomes. Since the launch of Treatment 2.0, the UNAIDS Secretariat and WHO have worked with other UNAIDS co-sponsoring organizations, technical experts and global partners to further elaborate and begin implementing Treatment 2.0. The Treatment 2.0 Framework for Action outlines the five priority work areas which comprise the core elements of the initiative and establishes a strategic framework to guide action within each of them over the next decade. The Framework for Action reflects commitments outlined in Getting to Zero: 2011 - 2015 Strategy, UNAIDS and the WHO Global Health-Sector Strategy on HIV, 2011 - 2015, the guiding strategies for the multi-sectoral and health-sector responses to the HIV pandemic. (Excerpt)
Monitoring equity in access to AIDS treatment programmes: a review of concepts, models, methods and indicators.
Geneva, Switzerland, WHO, 2010.  p.The World Health Organization (WHO) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust Malawi and Training and Research Support Centre (TARSC) developed this review. It provides a practical resource for programme managers, health planning departments, evaluation experts and civil society organizations working on health systems and HIV / AIDS programmes at sub-national, national and regional levels in East and Southern Africa. Many of the orientations and tools in this document were developed through a wide consultation process, starting in 2003. We draw on the broader analysis of health equity advanced by EQUINET, as well as evidence from five background studies on equity and health systems impacts of ART programming in East and Southern Africa which were supported by EQUINET, TARSC and DFID (available at www. equinetafrica.org). (Excerpt)
Science. 2010 Jul 9; 329(5988):147-9.This article focuses on the United Nations' goal of universal access to comprehensive programs for HIV prevention, treatment, care, and support by 2010, which has failed to deliver. It discusses how universal access can benefit other health programs such as progress towards universal access has directly advanced efforts to achieve several of the U.N. Millennium Development Goals (MDGs) but also includes why some criticize HIV-specific programs.
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.
[Bangkok, Thailand], ITPC, 2007 Dec.  p.In the first section of the report, nine country teams provide first-hand reports on central issues related to AIDS service scale-up in their countries. Each demonstrates that increasing access to AIDS treatment brings not only better life and new hope, but also shines light on challenges and effective approaches to a spectrum of health, poverty, and human rights issues. In part two of this report, 14 national teams review drug access issues, and find that global and national processes for AIDS drug registration are burdened by inefficiencies, duplications, delay, and, in some instances, corruption. In many cases key ARVs, particularly newer and second-line therapies, are not yet registered in high impact countries - an administrative roadblock that puts lifesaving care out of reach for hundreds of thousands of people. The report makes a number of concrete recommendations to the key players who are responsible for making near universal access to AIDS treatment a reality by 2010. (excerpt)
Lancet Infectious Diseases. 2008 Jan; 8(1):14.A report from the International Treatment Preparedness Coalition (ITPC) warns that meeting the "near universal access target" to AIDS drugs access by the 2010 deadline will require an enormous effort by governments, global agencies, and drug companies. According to the report, which looked at AIDS treatment access in 14 countries, "scale-up is working but high prices, patent and registration barriers, and ongoing stock-outs are core issues impeding AIDS drug delivery". "The issues highlighted in this report are real and widespread", said Nathan Ford of Médecins Sans Frontières (MSF; Johannesburg, South Africa). The HIV programmes run by MSF across the developing world are struggling against user fees, high drug costs, lack of human resources, and poor health infrastructure, he told TLID. The ITPC, a group of 1000 treatment activists from more than 125 countries, highlights that the high cost of antiretroviral drugs is a particular barrier in Argentina, China, and Belize. (excerpt)
Towards universal access: scaling up priority HIV / AIDS interventions in the health sector. Progress report, April 2007.
Geneva, Switzerland, WHO, 2007 Apr. 88 p.Drawing on lessons from the scale-up of HIV interventions over the last few years, WHO, as the UNAIDS cosponsor responsible for the health sector response to HIV/AIDS, has established priorities for its technical work and support to countries on the basis of the following five Strategic Directions, each of which represents a critical area where the health sector must invest if significant progress is to be made towards achieving universal access. Enabling people to know their HIV status; Maximizing the health sector's contribution to HIV prevention; Accelerating the scale-up of HIV/AIDS treatment and care; Strengthening and expanding health systems; Investing in strategic information to guide a more effective response. In this context, WHO undertook at the World Health Assembly in May 2006 to monitor and evaluate the global health sector response in scaling up towards universal access and to produce annual reports. This first report addresses progress in scaling up the following health sector interventions. Antiretroviral therapy; Prevention of mother-to-child transmission of HIV (PMTCT); HIV testing and counseling; Interventions for injecting drug users (IDUs); Control of sexually transmitted infections (STIs) to prevent HIV transmission; Surveillance of the HIV/AIDS epidemic. (excerpt)