AIDS 2014: A new target for HIV treatment from UNAIDS

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AIDS2014postScience Speaks is live-blogging from AIDS 2014 in Melbourne, Australia through the coming week, with updates on research, policy and insights from the 20th International AIDS Conference.

“If we can bring a bottle of Coke to every corner of Africa, we should be able to also deliver antiretroviral drugs”  Prof. Joep Lange

MELBOURNE, AUSTRALIA – Against the backdrop of a large screen photo of AIDS researcher Joep Lange, who died in Malaysian Airlines 17 crash last week, a high level panel Sunday discussed the UNAIDS new target for HIV treatment — 30 million by 2030.

281This means 90 percent of people would know their HIV status, 90 percent of HIV-infected individuals would access antiretroviral therapy and 90 percent of those on therapy would be virally suppressed. UNAIDS Executive Director Michel Sidibé defended what to many seems a bold target in the current financial climate.  “We refuse to listen to skeptics.  We always try to put people first.  Business as usual will hot get us to the end of this epidemic. If we are not ambitious we should not be in this business.”  He acknowledged that reaching the goal would require more funding, the elimination of human rights barriers, improved lab capacity, mass testing, the availability of a long-acting injectable antiretroviral treatment and task-shifting to expand the numbers and kinds of health care workers availability to provide treatment. UNAIDS hopes to have a price tag for the target by this September Luiz Loures, the agency’s deputy executive director for programs, said.

280“For all countries and populations,”
Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria stressed. That means refusing to accept the “tyranny of averages” and including of all vulnerable populations in the calculation, including young women in southern Africa, attending to the quality of programs and drilling down site by site, ensuring the supply chain of drugs. He also noted the need for a good second line antiretroviral combination product with components not used in first line regimens, and a point of care viral load test that is not vulnerable to heat or humidity. “We are at a tipping point in the epidemic, but tipping points can go either way,” he said.

Jarbas Barbosa, Vice-Minister of Health and Surveillance for Brazil and architect of the HIV program pledged Brazil’s commitment to the target and announced his own country’s commitment to reach 90 percent coverage by 2020. He noted that currently 84 percent of Brazilians living with HIV are aware of their status and called the fact that millions around the world neither know their status or have access to lifesaving treatment “unacceptable.”

Aaron Motsoaledi, the Minister of Health for South Africa spoke as “someone who has to implement this proposal.”  There are 35 million South Africans between the ages of 16 and 64 who must be prioritized for HIV counseling and testing. The HIV prevalence rate in South Africa is 17 percent, but prevalence for women using public sector health facilities is 29 percent.  “We have not yet won the war, and the end is not very near yet,” he said.  Treatment scale-up has been rapid in recent year with 2.5 million people now on treatment.  About half of these patients have had viral load testing, with some 75 percent virally suppressed.  Nevertheless, the numbers of patients lost to follow up after six months is very large, he noted.

To meet the targets, Motsoaledi said, most if not all of the population should test annually with mass testing in every possible setting. Linking everyone found to be HIV infected into care will require major changes in the service delivery platform because “our health facilities are already overstressed,” he said.  “We cannot increase the numbers of health care workers and facilities enough to meet the need.” He suggested that every patient will have to be digitally linked to a public health database for monitoring purposes, to reduce human resource demands. Group patients into support clubs may be necessary.

Despite the challenges, he was optimistic.

“I have been asked many times if we can afford to do this,” he said, “I always have one answer. Can we afford not to?”

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