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Allocation of antiretroviral drugs to HIV-infected patients in Togo: Perspectives of people living with HIV and healthcare providers.
Journal of Medical Ethics. 2017 Dec; 43(12):845-851.Aim To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. Method From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patient's family responsibilities and (d) the time elapsed since the first consultation. Results Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. Conclusions WHO's guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.
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)
Geneva, Switzerland, UNAIDS, 2007 Jan. 57 p. (UNAIDS/07.04E; JC1301E)In 2005 and early 2006, the landscape of the AIDS response shifted dramatically. Global pessimism over the unchecked spread of the disease in the developing world receded in the face of impressive efforts to expand access to treatment. Signs that prevention efforts were bearing fruit were seen in a growing number of countries from the hardest-hit regions, which started to report drops in HIV rates, particularly among the young. The global community had responded to urgent appeals by enormously increasing the financial resources available to fight the disease. While millions continued to die annually, these developments gave rise to hope that there was a light at the end of the tunnel. Unimaginable even a year or two earlier, it was now possible to start talking about the prospects of providing access to HIV prevention, treatment, care and support services to all who needed them. (excerpt)
Setting national targets for moving towards universal access. Further guidance to complement “Scaling Up Towards Universal Access: Considerations for Countries to Set their own National Targets for AIDS Prevention, Treatment, and Care and Support”. Operational guidance. A working document.
[Geneva, Switzerland], UNAIDS, 2006 Oct. 23 p.This document provides operational guidance to country-level partners and UN staff to facilitate the next phase of the country-level consultative process on scaling up towards universal access to prevention, treatment, care and support services. It concerns the setting of ambitious targets for the national HIV response to achieve by 2008 and 2010, and builds on previous guidelines. Targets need to be ambitious in order to achieve the universal access goals. Analysis by UNAIDS of existing national targets and rates of scaling up indicates that current efforts are inadequate to achieve universal access in the near future. The process of countries setting their own targets will promote partner alignment to national priorities, strengthen accountability and facilitate efforts by countries and international partners to mobilize international support and resources. Targets should have political and social legitimacy. The consultative process should be multi-sectoral, include full civil society participation, lead to consensus on the targets, and formal approval of these targets before the end of 2006. (excerpt)
Towards universal access to prevention, treatment and care: experiences and challenges from the Mbeya region in Tanzania -- a case study.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2007 Mar. 49 p. (UNAIDS Best Practice Collection; UNAIDS/07.11E; JC1291E)This study takes stock of the situation in Mbeya in 2005, documenting the region's continuing efforts to build on the Regional Programme's strong comprehensive prevention approaches to further increase their coverage while strengthening the new district focus, expanding multisectoral work and making available antiretroviral treatment. In doing so, this study describes Mbeya's progress towards universal access and identifies ongoing challenges. Through its comprehensive, decentralized and multisectoral approaches and the continuing efforts of a variety of actors, the region appears to be in a better position to reach universal access than other parts of Tanzania and Africa in general. The experiences of the Mbeya region to date can serve as lessons learnt to other parts of the country and, more broadly, the continent. This publication is neither a scientific study nor an evaluation of the Regional Programme. It is an analytical description of HIV control activities in the region to date and their status to date. Its focus is mainly on access. The programmes presented here follow national and international recommendations. The quality of the individual programmes, however, has not been assessed for the purpose of this publication. (excerpt)
Towards universal access by 2010. How WHO is working with countries to scale-up HIV prevention, treatment, care and support.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2006. 32 p.In 2005, leaders of the G8 countries agreed to «work with WHO, UNAIDS and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010». This goal was endorsed by United Nations Member States at the High-Level Plenary Meeting of the 60th Session of the United Nations General Assembly in September 2005. At the June 2006 General Assembly High Level Meeting on AIDS, United Nations Member States agreed to work towards the broad goal of "universal access to comprehensive prevention programmes, treatment, care and support" by 2010. Working towards universal access is a very ambitious challenge for the international community, and will require the commitment and involvement of all stakeholders, including governments, donors, international agencies, researchers and affected communities. Among the most important priorities is the strengthening of health services so that they are able to provide a comprehensive range of HIV/AIDS services to all those who need them. This document describes the contribution that the World Health Organization (WHO) will make, as the United Nations agency responsible for health, in working towards universal access to HIV prevention, treatment, care and support in the period 2006-2010. It proposes an evidence-based Model Essential Package of integrated health sector interventions for HIV/AIDS that WHO recommends be scaled up in countries, using a public health approach, and provides an overview of the strategic directions and priority intervention areas that will guide WHO's technical work and support to its Member States as they work towards universal access over the next four years. (excerpt)
The practice of charging user fees at the point of service delivery for HIV / AIDS treatment and care.
Geneva, Switzerland, WHO, 2005 Dec.  p. (WHO Discussion Paper; WHO/HIV/2005.11)The global movement to expand access to antiretroviral treatment for people living with HIV/AIDS as part of a comprehensive response to the HIV pandemic is grounded in both the human right to health and in evidence on public-health outcomes. However, for many individuals in poor communities, the cost of treatment remains an insurmountable obstacle. Even with sliding fee scales, cost recovery at the point of service delivery is likely to depress uptake of antiretroviral treatment and decrease adherence by those already receiving it. Therefore, countries are being advised to adopt a policy of free access at the point of service delivery to HIV care and treatment, including antiretroviral therapy. This recommendation is based on the best available evidence and experience in countries. It is warranted as an element of the exceptional response needed to turn back the AIDS epidemic. With the endorsement by G8 leaders in July 2005 and UN Member States in September 2005 of efforts to move towards universal access to HIV treatment and care by 2010, health sector financing strategies must now move to the top of the international agenda. Rapid scale-up of programmes within the framework of the "3 by 5" target has underscored the challenge of equity, particularly for marginalized and rural populations. It is apparent that user charges at the point of service delivery "institutionalize exclusion" and undermine efforts towards universal access to health services. Abolishing them, however, requires prompt, sustained attention to long-term health system financing strategies, at both national and international levels. (excerpt)
Scaling up HIV / AIDS prevention, treatment and care: a report on WHO support to countries in implementing the “3 by 5” Initiative, 2004-2005.
Geneva, Switzerland, WHO, 2006. 143 p.In September 2003, LEE Jong-wook, Director-General of WHO, and Peter Piot, Executive Director of UNAIDS, declared the lack of access to antiretroviral therapy for HIV/AIDS in low- and middle-income countries to be a global health emergency. Shortly after this declaration, WHO and its partners launched a global initiative to scale up antiretroviral therapy with the objective of having 3 million people receiving antiretroviral therapy - representing half the total number of those globally in need - by the end of 2005 ("3 by 5"). Although the actual target of putting 3 million people on antiretroviral therapy was not reached by the end of 2005, countries have made significant progress in the past two years in expanding treatment coverage, strengthening prevention and building the capacity of health systems to deliver long-term, chronic care. Overall, in the two-year period, antiretroviral therapy coverage in low- and middle-income countries increased from 7% of those in need at the end of 2003 (400 000 people) to 20% of those in need at the end of 2005 (1.3 million people). Eighteen countries managed to increase antiretroviral therapy coverage to half or more of the people who needed it, consistent with the "3 by 5" target. (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)
Treatment strategies for HIV-infected patients with tuberculosis: Ongoing and planned clinical trials.
Journal of Infectious Diseases. 2007 Aug 15; 196 Suppl 1:S46-S51.Currently, there are limited data to guide the management of highly active antiretroviral therapy (HAART) for human immunodeficiency virus type 1 (HIV-1)-infected patients with active tuberculosis (TB), the leading cause of death among individuals with acquired immunodeficiency syndrome (AIDS) in resource-limited areas. Four trials to take place in Southeast Asian, African, and South American countries will address the unresolved question of the optimal timing for initiation of HAART in patients with AIDS and TB: (1) Cambodian Early versus Late Introduction of Antiretrovirals (CAMELIA [ANRS 1295/NIH-CIPRA KH001]), (2) Adult AIDS Clinical Trials Group A5221, (3) START, and (4) a trial sponsored by the World Health Organization/Special Programme for Research and Training in Tropical Diseases. Two other clinical questions regarding patients with TB and HIV-1 coinfection are also undergoing evaluation: (1) the benefits of short-term HAART when CD4 cell counts are > 350 cells/mm3 (PART [NIH 1 R01 AI051219-01A2]) and (2) the efficacy of a once-daily HAART regimen in treatment-naive patients (BKVIR [ANRS 129]). Here, we present an overview of these ongoing or planned clinical studies, which are supported by international agencies. (author's)
London, England, International Community of Women Living with HIV / AIDS, 2006.  p.WHO supported ICW to map positive women's experiences of access to care and treatment in three countries - Namibia, Kenya and Tanzania. The findings will contribute to advocacy for increased political support and resources to address gendered barriers to care, treatment and support. The project complements a mapping and database of civil society organizations (CSOs) providing treatment by the French consortium - SIDACTION. This mapping presents results from three focus group discussions with HIV positive women conducted in two districts of Tanzania - Arusha and Moshi (2006). Women who participated in these focus group discussions were aged between 30 to 45. Most of them came from villages Munduli (Arusha) and Seliani (Moshi). Three focus groups were also conducted with men only in Arusha. A mixed-sex focus group was conducted in Chalinze in the Bagamoyo district (Dar es Salaam coastal area) with men and women aged between 35 and 42. There were between 12 - 15 participants in each group in Arusha and Mosh. However, in Chalinze there were only 8 people. Results from the mixed sex and men only focus groups are presented here but the main emphasis is on the results from the women only focus groups. Medical personnel were also interviewed and their experiences are included. (excerpt)
London, England, International Community of Women Living with HIV / AIDS, 2006.  p.Namibia, Kenya and Tanzania. The findings will contribute to advocacy for increased political support and resources to address gendered barriers to care, treatment and support. The project complements a mapping and database of civil society organizations (CSOs) providing treatment by the French consortium - SIDACTION. The research was carried out in Homabay (rural) and Kibera community (urban) involving women and men living with HIV and AIDS (13th December 2005 - 31st January 2006). Data was gathered through questionnaires and focus group discussions (FGDs). Women who participated in the focus group discussions were aged between 22 - 45 years old and in total 100 people took part in the project, including questionnaire respondents. The service providers in both sites were of varied age group (28-45 years) and both female and male service providers participated in the focus group discussions. Results from the mixed sex and service provider focus groups are presented here but the main emphasis is onthe results from the women only focus groups. (excerpt)
Progression to WHO criteria for antiretroviral therapy in a 7-year cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire.
Bulletin of the World Health Organization. 2007 Feb; 85(2):116-123.The objective was to estimate the probability of reaching the criteria for starting highly active antiretroviral therapy (HAART) in a prospective cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire. We recruited participants from HIV-positive donors at the blood bank of Abidjan for whom the delay since the estimated date of seroconversion (midpoint between last negative and first positive HIV-1 test) was = 36 months. Participants were offered early trimethoprim-sulfamethoxazole (cotrimoxazole) prophylaxis, twice-yearly measurement of CD4 count and we made standardized records of morbidity. We used the Kaplan-Meier method to estimate the probability of reaching the criteria for starting HAART according to WHO 2006 guidelines. 217 adults (77 women (35%)) were followed up during 668 person-years (PY). The most frequent diseases recorded were mild bacterial diseases (6.0 per 100 PY), malaria (3.6/100 PY), herpes zoster (3.4/100 PY), severe bacterial diseases (3.1/100 PY) and tuberculosis (2.1/100 PY). The probability of reaching the WHO 2006 criteria for HAART initiation was estimated at 0.09, 0.16, 0.24, 0.36 and 0.44 at 1, 2, 3, 4 and 5 years, respectively. Our data underline the incidence of the early HIV morbidity in an Ivorian adult population and provide support for HIV testing to be made more readily available and for early follow-up of HIV-infected adults in West Africa. (author's)
Breaking barriers. Effective communication for universal access to HIV prevention, treatment, care and support by 2010.
Lusaka, Zambia, Panos Southern Africa, Panos Global AIDS Programme, 2006. 25 p.Effective HIV and AIDS communication is central to the achievement of universal access. This paper reviews lessons learned from the response so far and suggests that there is an urgent need to strengthen communication approaches that look beyond narrow, short-term interventions focused on individual behaviours. Development actors must realistically and effectively engage the social, political and economic drivers of the epidemic, in a way that is informed by the experiences and priorities of those most affected. There is also a need to better understand and engage with the distinct communication dynamics of social movements and the neglected area of interpersonal communication - both of which are key to an effective response. The intransigent problems of stigma and discrimination must also be addressed. The challenge is at once social, political and technical, but without this paradigm shift in development and communication practice, universal access will remain elusive. As country-level plans for universal access are being developed in late 2006, it is vital that they explicitly include fully resourced communication strategies, activities and targets that are integrated into programming at all levels. Communication challenges include: the effective coordination of the response; sustained advocacy to tackle the underlying drivers of the epidemic; and the specific communication needs of prevention, treatment and care initiatives that require grassroots ownership and social mobilisation. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006 Mar 30.  p.This independent formative evaluation was conducted by a team of six international consultants between August 2005 and January 2006 to appraise WHO's contributions and roles in implementing the "3 by 5" Initiative. Funded by the Canadian Government, and as a requirement for its grant to WHO, the evaluation investigated all three levels at which WHO operates (headquarters, regional offices and country offices), placing particular emphasis on Africa. This included seven country assessments and an extensive consultation of international and country-level partners and stakeholders. A number of focused technical studies were also commissioned. The evaluation reviewed how effectively WHO provided technical, managerial and administrative guidance and support pursuant to the "3 by 5" goals and target. An assessment was also made of the extent to which WHO has mobilized, sustained and contributed to this major global partnership through improving harmonization between United Nations agencies and working with other stakeholders and partners. Key lessons from "3 by 5" have been documented, including those on how the initiative contributed to health systems strengthening and HIV prevention, as well as the ways with which equity and gender concerns were dealt. Potential opportunities for future collaboration between WHO, main donors and partners were identified and recommendations have been provided for future plans and the way forward for WHO and its partners. (excerpt)
CommonHealth. 2005 Spring; 36-43.As defined by the World Health Organization (WHO):2 Palliative medicine is the study and management of patients with active, progressive, far advanced disease for whom the prognosis is limited and the focus of care is the quality of life. [It is] the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are applicable earlier in the course of the illness, in conjunction with treatment. Palliative care: Affirms life and regards dying as a normal process; Neither hastens, nor postpones, death; Provides relief from pain and other distressing symptoms; Integrates the psychological and spiritual aspects of patient care; Offers a support system to help patients live as actively as possible until death; and Offers a support system to help families cope during a patient's illness and with their own bereavement. In short, palliative care comprehensively addresses the physical, emotional, and spiritual impact a life-threatening illness has on a person, no matter the stage of the illness. It places the sick person and his/her family, however defined, at the center of care and aggressively addresses all of the symptoms and problems experienced by them. Many healthcare providers apply certain elements of the palliative care treatment approach-- such as comprehensive care and aggressive symptom management-- to the care of all of their patients, not only those who are terminally ill, offering the type of care we would all like to receive when we are sick. (excerpt)
HIV and AIDS treatment education: a critical component of efforts to ensure universal access to prevention, treatment and care. UNAIDS Inter-Agency Task Team (IATT) on Education.
Paris, France, UNESCO, 2006 Jun. 50 p. (ED.2006/WS/11309713)This paper explores some of the issues contained within the definition of treatment education, signalling ways that the education sector can play a role along with others engaged in treatment access and education. It considers some key strategies, including how to effectively engage and prepare communities and how to involve key constituencies, particularly people with HIV and those on treatment. Moreover, the paper reexamines the harmful effects of stigma and discrimination and how these impede progress in prevention as well as expanded treatment access. The paper also suggests some possible future directions, underscoring areas of particular priority. These include the need for: Identification, documentation and wide dissemination of effective approaches to treatment education that are feasible, sustainable and that can be scaled up; Development of practical guidelines and materials that can be used by programme implementers to support the integration of treatment education within ongoing HIV and AIDS education efforts; Ongoing and close communication with authorities and organizations responsible for expanding treatment access to ensure coherent and well-coordinated programming. (excerpt)
The 10-year struggle to provide antiretroviral treatment to people with HIV in the developing world.
Lancet. 2006 Aug 5; 368(9534):541-546.In March, 2006, the WHO took stock of the 3 by 5 initiative, which had been formally launched with UNAIDS 2 years earlier. With 1.3 million people on antiretroviral treatment in developing countries by the end of 2005, the world had not reached the target of treating 3 million people living with HIV/AIDS. In terms of numbers, at least, some said that the campaign failed. But the initiative did show that with the right vision and a determined effort by all relevant parties, development achievements that seem unthinkable are indeed possible. The apparent failure to achieve what was always an aspirational goal should not overshadow the fact that the progress on access to antiretroviral treatment might have no precedent in global public health. For no other life-threatening disease has the world moved from the first scientific breakthroughs to a commitment to achieve universal access to treatment in less than a decade. But we should not forget that the number of new HIV infections still outpaces the expansion of access to treatment, and that progress remains slow in view of the millions still dying from AIDS every year. (excerpt)
The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings.
Lancet. 2006 Aug 5; 368(9534):505-510.WHO has proposed a public-health approach to antiretroviral therapy (ART) to enable scaling-up access to treatment for HIV-positive people in developing countries, recognising that the western model of specialist physician management and advanced laboratory monitoring is not feasible in resource-poor settings. In this approach, standardised simplified treatment protocols and decentralised service delivery enable treatment to be delivered to large numbers of HIV-positive adults and children through the public and private sector. Simplified tools and approaches to clinical decision-making, centred on the "four Ss"--when to: start drug treatment; substitute for toxicity; switch after treatment failure; and stop--enable lower level health-care workers to deliver care. Simple limited formularies have driven large-scale production of fixed-dose combinations for first-line treatment for adults and lowered prices, but to ensure access to ART in the poorest countries, the care and drugs should be given free at point of service delivery. Population-based surveillance for acquired and transmitted resistance is needed to address concerns that switching regimens on the basis of clinical criteria for failure alone could lead to widespread emergence of drug-resistant virus strains. The integrated management of adult or childhood illness (IMAI/IMCI) facilitates decentralised implementation that is integrated within existing health systems. Simplified operational guidelines, tools, and training materials enable clinical teams in primary-care and second-level facilities to deliver HIV prevention, HIV care, and ART, and to use a standardised patient-tracking system. (author's)
Choices. 2004; 4-5.This approach is underpinned by promoting leadership in government, in civil society, in the private sector and in communities. We promote leadership of people living with HIV/AIDS and women's leadership to ensure that they participate in planning and implementing HIV/AIDS responses. We also work with a broad range of partners, including from the media and in the arts, to generate society-wide responses that are gender-sensitive and respect the rights of people living with HIV/AIDS. We also work to strengthen community capacity for action and social change by helping communities to address the underlying causes of the epidemic. (excerpt)
New England Journal of Medicine. 2006 Jun 8; 354(23):2414-2417.On June 5, 1981, when the Centers for Disease Control reported five cases of Pneumocystis carinii pneumonia in young homosexual men in Los Angeles, few suspected it heralded a pandemic of AIDS. In 1983, a retrovirus (later named the human immunodeficiency virus, or HIV) was isolated from a patient with AIDS. In the 25 years since the first report, more than 65 million persons have been infected with HIV, and more than 25 million have died of AIDS. Worldwide, more than 40 percent of new infections among adults are in young people 15 to 24 years of age. Ninety-five percent of these infections and deaths have occurred in developing countries. Sub-Saharan Africa is home to almost 64 percent of the estimated 38.6 million persons living with HIV infection. In this region, women represent 60 percent of those infected and 77 percent of newly infected persons 15 to 24 years of age. AIDS is now the leading cause of premature death among people 15 to 59 years of age. In the hardest-hit countries, the foundations of society, governance, and national security are eroding, stretching safety nets to the breaking point, with social and economic repercussions that will span generations. (excerpt)
BMJ. British Medical Journal. 2006 Jun 3; 332(7553):1289.The world is doing better than it was to combat AIDS but is still not doing enough, says the 2006 report on the global epidemic by UNAIDS, the joint United Nations project on HIV and AIDS. The report comes 25 years after the disease, which UNAIDS describes as “among the greatest development challenges in human history,” was first recognised. It was presented at a press conference in New York on Tuesday, the day before the opening of the UNAIDS 2006 high level meeting on AIDS. Peter Piot, executive director of UNAIDS, Ann Veneman, executive director of Unicef, and Thoraya Obaid, executive director of the UN Population Fund, spoke at the press conference. They said that 126 countries had submitted full reports. (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)
Bulletin of the World Health Organization. 2006 Feb; 84(2):145-150.This paper reviews the data sources and methods used to estimate the number of people on, and coverage of, antiretroviral therapy (ART) programmes in low- and middle-income countries and to monitor the progress towards the "3 by 5" target set by WHO and UNAIDS. We include a review of the data sources used to estimate the coverage of ART programmes as well as the efforts made to avoid double counting and over-reporting. The methods used to estimate the number of people in need of ART are described and expanded with estimates of treatment needs for children, both for ART and for cotrimoxazole prophylaxis. An estimated 6.5 million people were in need of treatment in low- and middle-income countries by the end of 2004, including 660,000 children under age 15 years. The mid-2005 estimate of 970,000 people receiving ART in low- and middle-income countries (with an uncertainty range 840,000-1,100,000) corresponds to a coverage of 15% of people in need of treatment. (author's)
Finance and Development. 2005 Dec; 42(4): p..After close to two decades of neglect, battling the HIV/AIDS epidemic has become one of the highest priorities on the global agenda. UNAIDS estimates that some 40 million people are living with HIV—25 million of them in sub- Saharan Africa and 8 million in Asia—with close to 5 million people newly infected in 2004 alone. AIDS-related deaths total about 3 million people each year, with adults and children in Africa dying at the rate of 7,000 per day. In the short term, the loss of a large segment of adults in their prime, particularly women, devastates households. Over the long term, losses in human capital formation pose a further risk by decreasing the intergenerational transfer of knowledge and creating macroeconomic threats, especially in the hardest-hit countries. Prevention through behavioral change has proved difficult, and a vaccine remains elusive. In response, the international community has mobilized billions of dollars for HIV/AIDS, with many low-income countries already receiving, or pledged to receive, huge sums. However, the recipients of these funds find themselves grappling with tough dilemmas. Could the size of the inflows be so large as to undermine macroeconomic stability or fiscal management? Can they—in a short period—effectively utilize the resources made available, or even the amounts already pledged and committed, given the institutional capacity and governance problems that often plague their health care systems? And can they mobilize the needed "collateral" domestic resources (such as labor, infrastructure, and an institutional base) to rapidly scale up services? (excerpt)