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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.
Geneva, Switzerland, UNAIDS, 2016. 12 p.Gender inequalities and harmful gender norms are important drivers of the HIV epidemic, and they are major hindrances to an effective HIV response. While access to HIV services for women and girls remain a concern, a growing body of evidence also shows that men and adolescent boys have limited access to HIV services. Current effort to advance both gender equality and sexual and reproductive health and rights as key elements of the HIV response do not adequately reflect the ways that harmful gender norms and practices negatively affect men, women and adolescent body and girls in all their diversity. This in turn increases HIV-related vulnerability and risk among all of these groups.
Projected Uptake of New Antiretroviral (ARV) Medicines in Adults in Low- and Middle-Income Countries: A Forecast Analysis 2015-2025.
PloS One. 2016; 11(10):e0164619.With anti-retroviral treatment (ART) scale-up set to continue over the next few years it is of key importance that manufacturers and planners in low- and middle-income countries (LMICs) hardest hit by the HIV/AIDS pandemic are able to anticipate and respond to future changes to treatment regimens, generics pipeline and demand, in order to secure continued access to all ARV medicines required. We did a forecast analysis, using secondary WHO and UNAIDS data sources, to estimate the number of people living with HIV (PLHIV) and the market share and demand for a range of new and existing ARV drugs in LMICs up to 2025. UNAIDS estimates 24.7 million person-years of ART in 2020 and 28.5 million person-years of ART in 2025 (24.3 million on first-line treatment, 3.5 million on second-line treatment, and 0.6 million on third-line treatment). Our analysis showed that TAF and DTG will be major players in the ART regimen by 2025, with 8 million and 15 million patients using these ARVs respectively. However, as safety and efficacy of dolutegravir (DTG) and tenofovir alafenamide (TAF) during pregnancy and among TB/HIV co-infected patients using rifampicin is still under debate, and ART scale-up is predicted to increase considerably, there also remains a clear need for continuous supplies of existing ARVs including TDF and EFV, which 16 million and 10 million patients-respectively-are predicted to be using in 2025. It will be important to ensure that the existing capacities of generics manufacturers, which are geared towards ARVs of higher doses (such as TDF 300mg and EFV 600mg), will not be adversely impacted due to the introduction of lower dose ARVs such as TAF 25mg and DTG 50mg. With increased access to viral load testing, more patients would be using protease inhibitors containing regimens in second-line, with 1 million patients on LPV/r and 2.3 million on ATV/r by 2025. However, it will remain important to continue monitoring the evolution of ARV market in LMICs to guarantee the availability of these medicines.
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.
Geneva, Switzerland, UNAIDS, .  p.In October 2015, the UNAIDS Programme Coordinating Board adopted a new strategy to end the HIV epidemic as a public health threat by 2030. The UNAIDS 2016-2021 Strategy is one of the first in the United Nations system to be aligned to the Sustainable Development Goals framework. This framework, which guides global development policy over the next 15 years, includes ending the HIV epidemic by 2030. The strategy, informed by evidence and rights-based approaches, maps out the UNAIDS Fast-Track approach to accelerate the HIV response over the next five years so as to reach critical HIV prevention and treatment targets and achieve zero discrimination. The strategy also endorses achieving 90–90–90 treatment targets, closing the testing gap, and protecting the health of the 22 million people living with HIV who are still not accessing treatment. Additionally, it urges protecting future generations from acquiring HIV by eliminating all new HIV infections among children, and by ensuring that young people can access needed services for HIV and sexual and reproductive health. The strategy emphasizes that empowering young people, particularly young women, is of utmost importance to preventing HIV. This empowerment includes ending gender-based violence and promoting healthy gender norms.
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.
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, 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)
Lancet. 2010 Dec 4; 376(9756):1874.This editorial argues that despite the report by UNAIDS that the trajectory of the HIV epidemic has been broken, a US Institute of Medicine (IOM) report paints a bleaker picture for the immediate future of HIV/AIDS in Africa. The IOM report states that sub-Saharan Africa bears 68% of the worldwide burden of HIV infection and the gap is growing between the number of people needing treatment and the availability of resources.
Lancet. 2008 Jul 26; 372(9635):333-6.Funds available for HIV/AIDS programmes in low-income and middle-income countries rose from US$300 million in 1996 to $10 billion in 2007. However, a combination of worldwide economic uncertainty, a global food crisis, and publications that indicate discontent with progress in fighting the HIV/AIDS pandemic will not only threaten to restrict increases in the overall availability of both donor and national funds, but will also increase the competition for resources during the move towards universal access to treatment and prevention services. Thus, UNAIDS will be under increasing pressure in its presentation and justification of resources needed for HIV/AIDS programming. Here I discuss UNAIDS' 2007 estimates of resource requirements for fighting HIV/AIDS in terms of their usefulness to both donor and recipient governments for budget planning and for setting priorities for HIV/AIDS programmes. I identify weaknesses in the UNAIDS estimates in terms of financial transparency and priority setting, and recommend changes to improve budgeting and priority setting.
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)
A nongovernmental organization's national response to HIV: the work of the All-Ukrainian Network of People Living with HIV.
Geneva, Switzerland, UNAIDS, 2007 Jul. 47 p. (UNAIDS Best Practice Collection; UNAIDS/07.23E; JC1305E)The All-Ukrainian Network of People Living with HIV/AIDS (the 'Network') was formed in the late 1990s by HIV-positive individuals alarmed at the surging HIV epidemic in their country and the lack of resources and support for themselves and others living with the virus. It has grown rapidly and steadily since then, providing services and support to more than 14 000 people living with HIV. Its roots are in the self-help ethos, based on the belief that people living with HIV must be directly involved in leading national and local responses to HIV. The Network's four key strategy components are: increasing access to non-medical care, treatment and support; lobbying and advocating to protect the rights of people living with HIV; seeking to increase acceptance towards people living with HIV throughout society; and enhancing the organizational capacity of the Network. (excerpt)
Geneva, Switzerland, UNAIDS, .  p.Funding for AIDS has grown significantly over the past decade. In 2007, US$10 billion is expected to be available for the AIDS response - about one third coming from developing countries - compared to less than US$300 million in 1995. The substantial increase in financial resources has allowed countries to scale up their AIDS response with the ultimate goal of achieving universal access to HIV prevention, treatment, care and support. However, many countries face difficulties in effectively implementing large-scale grants made available by funding bodies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, and bilateral actors. They require rapid and adequate technical support to effectively implement AIDS programmes. To address this implementation challenge, UNAIDS has taken a leading role in "making the money work" in countries. It has invested significant resources over the past two years in strengthening countries' national AIDS programmes, particularly through the establishment of Technical Support Facilities in five regions. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Jul. 64 p. (UNAIDS/07.XXE; JC1364E)Great strides have been made in reaching communities affected by biomedical HIV prevention trials with information, discussion fora and skills-building that effectively empower them to work as partners with researchers in critical aspects of trial design and conduct. However, there is no existing, standard and internationally recognized guidance that primarily addresses 'Good Participatory Practice' and community engagement in biomedical HIV prevention trials. Increasing the awareness of researchers, funders, trial participants, and community stakeholders of essential good practices for community engagement through these guidelines can help reduce unnecessary conflict, confusion, or non-constructive criticism and ensure that research is meaningful, applicable, and correctly interpreted. Serving as a reference for agreements about basic Good Participatory Practice elements for optimum trial conduct and related investments of necessary human and financial resources, this guidance document for those who conduct, fund, participate in and assess trial conduct can act as a positive incentive for all parties to strive for effective community involvement. (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)