Africa: AIDS Progress Real but Limited, 01/28/05

Africa: AIDS Progress Real but Limited

AfricaFocus Bulletin
Jan 28, 2005 (050128)
(Reposted from sources cited below)

Editor's Note

The number of Africans receiving anti-retroviral treatment more than doubled from 150,000 to 310,000 in the last six months of 2004, the World Health Organization (WHO) reported this week. For those on treatment, treatment adherence and survival rates were comparable to or even better than the rates in developed countries. But there are still more than ten times that many Africans who need AIDS treatment now but are not receiving it: 3.7 million people in sub-Saharan Africa alone, out of 5.1 million worldwide.

The report demonstrates that progress is possible, despite the difficulties of coordination among multiple programs at the global, bilateral, and national levels. One additional barrier to progress was toppled this week when the US Food and Drug Administration approved a set of generic anti-retroviral drugs produced by the South African drug manufacturer Aspen, making it possible for countries to purchase these drugs using funds from the US bilateral AIDS program.

Many on the frontlines of the war against AIDS, comparing the numbers with the need rather than with past performance, say these limited successes are too little and too late. Doctors Without Borders, which has led the way in AIDS treatment and now provides treatment to some 25,000 patients, issued a press release saying treatment expansion is still moving "at a snail's pace," and that many crucial issues are not being addressed, including treatment for children (see
http://www.doctorswithoutborders.org/pr/2005/01-27-2005.shtml).

Despite its emphasis on progress, the WHO report also identifies formidable gaps in both money and capacity needed to provide treatment this year to 2.3 million more people, to reach WHO's minimum goal of 3 million. There is still a cash shortfall of approximately $2 billion, more than half the estimated minimum of $3.5 billion needed in 2005.

Another critical gap, the report stresses, is the capacity of health systems, including in personnel and administration. Strengthening these systems is essential to the goal of increasing AIDS treatment. It is also required in order to ensure that scaling up AIDS treatment enhances the delivery of all health services, rather than diverting scarce resources from other health priorities.

This AfricaFocus Bulletin contains excerpts from a press release announcing the report, released at the World Economic Forum in Davos, from a fact sheet accompanying the 64-page report, and from the executive summary and country case studies included in the report. [Excerpts from country cases in web version of bulletin only. See http://www.africafocus.org/docs05/who0501.php#country]

The full report, including graphs, is available at http://www.who.int/3by5/progressreport05/en

For previous AfricaFocus Bulletins on AIDS and other health issues, see http://www.africafocus.org/healthexp.php

For ongoing news on African health, visit http://allafrica.com/health

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Joint Media Release WHO/UNAIDS/Global Fund/US Government

26 January 2005

700,000 People Living with Aids in Developing Countries Now Receiving Treatment

Partnerships Across All Sectors Are Driving Treatment Scale up

Davos

By the end of 2004, 700 000 people living with AIDS in developing countries were receiving antiretroviral (ART) treatment thanks to the efforts of national governments, donors and other partners. This is an increase of approximately 75% in the total number receiving treatment from a year ago, and is up from 440 000 in July 2004.

Today, at a joint press conference at the World Economic Forum's Annual Meeting, Switzerland, the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United States Government and the Global Fund to fight AIDS, Tuberculosis and Malaria revealed the results of their joint efforts to increase the availability of ART in poor countries. They underlined that progress has been made thanks to extensive collaboration and unity of purpose. However all the organizations warned that major, continued efforts are needed in countries and internationally to continue working towards the goal of access to treatment for all who need it.

"We salute the countries who have now shown us that treatment is possible and can be scaled up quickly even in the poorest settings. AIDS treatment access is expanding every day thanks to the dedicated work of doctors, nurses, health workers and people living with HIV and AIDS, who are often working under difficult circumstances to turn the dream of universal treatment into a reality," said Dr Lee Jong-wook, WHO Director-General.

The organizations warned that there are still very real challenges to reaching the goal of universal access to treatment. In many countries, the speed of progress has rapidly increased, but to achieve universal access, the international community and national governments need to do much more to translate political and financial commitments into real actions in countries.

"The heart and soul of President Bush's Emergency Plan for AIDS Relief is to work shoulder to shoulder with host governments and our other partners in those nations in support of the national strategy of each country," said Ambassador Randall Tobias, the US Global AIDS Coordinator. "Although the results are being discussed today by donors and international organizations, the results were achieved by the work of talented and dedicated people in-country. We are dedicated to supporting their efforts, but the true credit rests with them."

Collaboration across all sectors is making treatment happen. Treatment is happening because national governments are taking the lead to coordinate efforts with all partners to scale up treatment in rural and urban areas. The Global Fund is providing flexible funds to governments and projects. The United States is funding, as well as providing technical assistance and guidance for, program and capacity development to support national strategies. WHO and UNAIDS are providing guidance and technical assistance to help countries turn finance into programmes. NGOs, faith-based organizations, networks of people living with HIV/AIDS and the private sector are all contributing.

"Collaboration over the past year has shown that several initiatives can work in tandem to achieve real acceleration. While today's figures are encouraging, the work so far has been laying the ground work for a much larger expansion in the months and years to come," said Dr Richard Feachem, Executive Director of the Global Fund to fight AIDS, TB and Malaria.

WHO and UNAIDS believe the current figures are the most accurate estimates to date. They are based on a composite of numbers given by countries and partners. In the region with the heaviest burden

• sub-Saharan Africa - the number of people on treatment has doubled over six months from 150 000 to 310 000. In Asia, the figure has doubled since June from 50 000 to 100 000. In Latin America and the Caribbean, the numbers continued to improve and there are now 275 000 people on treatment in this region. Botswana and more than ten countries in Latin America are already treating 50% or more of those in need in their countries. Building on years of AIDS awareness and prevention programmes, Uganda and Thailand are expected to be treating 50% or more people needing ART in the first half of 2005.

At the beginning of December 2004, 240 000 people were on treatment as a result of financing by the US government and the Global Fund. This number is increasing rapidly as newly started treatment programmes accelerate.

"We know that treatment is more than just access to antiretrovirals," said Dr Peter Piot, UNAIDS Executive Director. "People living with HIV need comprehensive services, from testing and counselling to nutritional support. Just as there is an urgent need to increase access to treatment, we must also renew our commitment to preventing new HIV infections."

WHO and UNAIDS estimate that at the end of 2004 around six million people were in need of treatment in developing countries. In December 2003 WHO, UNAIDS and UN partners announced the "3 by 5" target, challenging countries to get three million people or half of those in need on treatment by the end of 2005. WHO and UNAIDS estimate that overall 72% of un-met need for treatment is in Sub-Saharan Africa; 22% is in Asia; India, Nigeria and South Africa alone account for 41% of the overall need for treatment. The "3 by 5" target can only be reached if major progress is made in the countries with the greatest unmet need.

WHO and UNAIDS today published the results of global efforts to increase the availability of ART in poor countries in the second "3 by 5" Progress Report. The total of 700 000 people receiving treatment reaches the interim target for 2004, as outlined in the WHO/UNAIDS "3 by 5" strategy.

For further information please contact:

World Health Organization - Iain Simpson, Mobile: +4179 475 5534 Global Fund - Jon Liden, Mobile +4179 244 6006 UNAIDS - Dominique De Santis, Tel: +4122 791 4509, Mobile: +4179 254 6803
US Govt - Elissa Pruett, Mobile: +1202 521 2177 World Economic Forum - Mark Adams, Director of Media, Tel: +41 (0)22 869 1212, Fax: +41 (0)22 869 1394, mark.adams@weforum.org

"3 by 5" Progress Report December 2004

Executive summary

Statistical overview

In the second half of 2004, the number of people on antiretroviral (ARV) therapy in developing and transitional countries increased dramatically from 440,000 to an estimated 700,000. This figure represents about 12% of the approximately 5.8 million people currently needing treatment in developing and transitional countries and includes people receiving ARV therapy supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President's Emergency Plan for AIDS Relief, the World Bank and other partners.

In sub-Saharan Africa, the number of people on treatment doubled from 150 000 to 310 000 in just six months. In Botswana, Kenya, South Africa, Uganda and Zambia the number of people receiving treatment increased by more than 10 000 in each country. Botswana, Namibia and Uganda now have an estimated ARV therapy coverage that exceeds one quarter of all people needing treatment, and 13 countries in the region have exceeded 10% coverage. This region now has well over 700 sites that can deliver ARV therapy.

In East, South and South-East Asia, 100,000 people were on treatment by the end of 2004, twice the number reported six months previously. Thailand is leading the way, expanding treatment access to all districts with more than 900 ARV therapy facilities and starting more than 3000 people on treatment every month.

In Latin America and the Caribbean, access to ARV therapy continued to improve. Brazil has led the way by providing access to ARV therapy for its entire population, but nine more countries also have estimated coverage rates exceeding 50%. Progress in Eastern Europe, Central Asia, North Africa and the Middle East has generally been much slower.

Initial data show that treatment success rates in developing countries are just as good as those in affluent industrialized countries. Adherence to regimens is as high as 90% and treatment benefi ts to individuals are dramatic, with survival rates exceeding 90% after one year and 80% after two years of ARV therapy.

...

During the second half of 2004, an additional 40,000 to 50, 000 people initiated treatment each month worldwide. Nevertheless, there are enormous barriers to reaching the target in 2005. Many of the advances have been geographically uneven: critical building blocks are still missing in far too many areas of highburden countries.

The success of "3 by 5" will ultimately be determined by the action taken in countries, by governments, civil society, health care providers and partner organizations. Political will demonstrated at the highest possible level in any individual country will be decisive in determining whether it reaches its target. Governments can also be encouraged by the flexibility and creativity already displayed by major donors in making money move to where it is needed most, but their efforts must now be taken to the next level.

Given present system costs, at least US$ 2 billion in sustained additional funding from national governments and external funders will be necessary to provide access to ARV therapy for approximately 2.3 million people.

The resource gap is only one of many difficult obstacles that confront us. Cost of ARV medicines to countries and individuals is an area of particular concern, as is the geographical distribution of services related to HIV/AIDS and human resources. There is still a critical need to improve the infrastructure for delivery of care and treatment. Organizations working in the field of HIV/AIDS must ensure that their efforts offer real solutions to the very real problems countries will face. However, progress in 2004 has laid the foundations for an extraordinary push to reach the "3 by 5" target by the end of 2005.

Joint Fact Sheet WHO/UNAIDS/283

January 2005

"3 BY 5" PROGRESS - DECEMBER 2004

Progress: key points

• The world has met the 2004 target for "3 by 5"
  
  
• WHO/UNAIDS estimate that 700,000 people were on antiretroviral treatment (ART) in developing countries by the end of 2004. This reaches the "3 by 5" milestone for December 2004 as set out in the WHO/UNAIDS strategy.
  
  
• 700,000 represents over 12% of the estimated 5.8 million currently needing ART in developing and transitional countries.
  
  
• Botswana and more than ten countries in Latin America have already reached the "3 by 5" goal of treating 50% or more of people needing ART in their countries.2
  
  
• Thailand and Uganda are expected to reach the "3 by 5" target of treating 50% or more people needing ART in the first half of 2005.
  
  
• Cambodia, Cameroon, Kenya and Zambia have made much progress in increasing the number of ART sites throughout their countries. All are treating over 10% of the people in need.
  
  
• In the region with the heaviest burden of HIV/AIDS, sub-Saharan Africa, the number of people on ART has more than doubled over six months from 150,000 to 310,000.
  
  
• In Asia the number have doubled since June from 50,000 to 100,000.
  
  
• In Latin America and the Caribbean the figures continued to improve. There are now 275 000 people on ART in this region. Brazil has universal access to ART.
  
  
• The most successful countries are those that have shown commitment and leadership, including strategic use of their own resources and effective engagement of partners. The success of '3 by 5' ultimately depends upon country-level commitment and action.

Treatment works: Adherence rates high

• A growing number of countries have shown that increasing access to treatment is both possible and effective. Brazil has the most advanced national HIV/AIDS treatment programme in the developing

world

over a seven-year period, almost 100,000 deaths have been averted (a 50% drop in mortality) through the introduction of ART.

• Initial results show that adherence to simplified antiretroviral drug regimens, particularly those using fixed-dose combinations, is very high (around 90%). An initiative sponsored by the Government of Senegal has maintained good (80 - 90%) adherence over two to three years.
  
  
• The survival rate of AIDS patients is improving with increased access to ART. In a trial in Entebbe, Uganda, since January 2003, 90% of participants on ART were alive after 15 months of treatment.
  
  
• These figures are comparable or even better than those from developed countries.

Partnerships: Helping to drive treatment scale-up

• Over the last 12 months, a remarkable international movement has gathered behind the "3 by 5" target. Partnerships both within countries and globally, in the public and private sectors, are helping to drive the effort to increase access to ART.
  
  
• 136 partners are now formally involved in reaching the "3 by 5" target as advocates, donors, advisors, collaborators and providers of funding, technical and other services.
  
  
• Community activists and groups in countries - including people living with HIV and AIDS - have led the world in advocating for ART and in delivering medicines to people in need.
  
  
• Building on ongoing work in countries, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President's Emergency Plan for AIDS Relief and the World Bank have played a critical role in providing flexible funding.
  
  
• Organizations like the Clinton Foundation and Médecins Sans Frontières have been instrumental in lowering the price of first-line antiretroviral medicines.
  
  
• Ultimately it is countries that must take the lead. Brazil, Thailand and Uganda have been successful due to high-level political commitment, strategic use of their own resources and the effective engagement of partners, More countries need to follow their lead if "3 by 5" is to be accomplished.

Challenges: Key obstacles must be tackled urgently

• Another 2.3 million people need to initiate treatment by the end 2005 for the target to be met.
  
  
• Overall 72% of un-met need for treatment is in Sub-Saharan Africa; 22% is in Asia.
  
  
• South Africa, India and Nigeria alone account for 41% of the overall un-met need for treatment.
  
  
• The "3 by 5" target can only be reached if much progress is made in the countries with the greatest unmet need.
  
  
• There remain a number of difficult obstacles that need to be addressed:
  
  
• the high cost of first- and particularly second- line treatment and diagnostic tests;
  
  
• the lack of affordable and user-friendly AIDS medicines for children;
  
  
• the need to ensure equitable access to reach the most vulnerable, including sex workers, prisoners, injecting drug users;
  
  
• the need to rapidly accelerate and coordinate prevention and treatment services, and make better use of critical entry points such as TB and maternal health services;
  
  
• the need to increase the number of individuals who know their HIV status, in part through the routine offer of testing and counselling at critical health system entry points;
  
  
• the continued lack of adequate human resources, trained medical and non-medical health workers in affected communities. Increasing access to treatment must go hand in hand with increased

prevention efforts.

The resources gap: More funds urgently needed

• The flexibility and creativity displayed by major donors is extremely encouraging. Their support for increasing access to treatment must continue.
  
  
• Of the estimated US$ 3.5-3.8 billion needed to achieve the global "3 by 5" target, at least an additional US$2 billion is still needed.
  
  
• The resource gap can be cut by reductions in the costs of drugs or service delivery.
  
  
• To close the gap, highly affected countries and donor nations alike must strengthen their commitment and improve rates of disbursement.
  
  
• WHO needs US$ 60 million before the end of 2005 to provide the necessary technical assistance to countries to help them reach their targets.

What is WHO doing to help reach the "3 by 5" target?

• Developing international policy and vital guidelines for rapid HIV testing, efficient and simplified HIV diagnostics and AIDS treatments in order to provide more affordable and equitable HIV/AIDS services in developing countries.
  
  
• Developing training modules and organizing training sessions for medical and non- medical health workers to deliver HIV/AIDS services.
  
  
• Advising countries on building and managing antiretroviral procurement and distribution systems, monitoring and evaluation of scale-up progress, and planning and implementing grant proposals,
  
  
• Hiring and training "3 by 5" technical experts and programme managers to help countries in their efforts to increase access to treatment.
  
  
• Helping to strengthen civil society - particularly people living with HIV/AIDS (PLWHA) - locally, nationally and globally, through the 'Preparing for Treatment Programme', which contributes to the Collaborative Fund for Treatment Preparedness. Treatment literacy and treatment advocacy are important elements for PLWHA in order to fully participate in their own healthcare and to advocate for appropriate interventions for their communities.

Progress in Countries

[Excerpts from country cases, on Botswana, Cameroon, Mozambique, Zambia, and Malawi, in web version of bulletin only. See http://www.africafocus.org/docs05/who0501.php#country]

Africa: AIDS Progress Real but Limited

Page Editor: Ali B. Ali-Dinar, Ph.D.