Survey Says: HIV treatment scale up not so impressive in 23 countries

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Sharonann Lynch, HIV policy advisor at Medecins Sans Frontieres, highlights impediments to treatment scale up in 23 MSF countries Tuesday at the International AIDS Conference in Washington.

Much still needs to be done to get treatment to those who need it and to meet the UNAIDS-endorsed goal to achieve universal access by 2015, according to a new survey examining 25 HIV indicators assessing strategies, tools and policies to get the best HIV treatment to more people, sooner.

Medecins Sans Frontieres (MSF) released results for the first-of-its-kind study –assessing progress in areas such as providing HIV drugs for those requiring therapy, provision of prevention of mother-to-child transmission (PMTCT), and provision of services outside of centralized care settings and in the community – Tuesday at the International AIDS Conference in Washington.

The main findings from the “Speed Up Scale-Up” report, issued jointly from MSF and UNAIDS, showed that nine of the 23 countries surveyed have antiretroviral therapy (ART) coverage of those in need of treatment below fifty percent. Eighteen of the countries surveyed are in sub-Saharan Africa (SSA).

On a better note, the coverage rates for preventing mother-to-child transmission were above 80 percent in six of the countries, but eight are still below 50 percent coverage. And only eight of the 20 countries for which data was available were able to provide antiretroviral therapy (ART) in 30 percent or more of public-sector health facilities.

“Governments for the most part have shown themselves to be dynamic in changing policies allowing access to treatment,” said Sharonann Lynch, HIV policy advisor for MSF. These include allowing nurses to initiate ART (happening in 11 of the 18 countries surveyed in SSA), allowing basic HIV-related tasks such as HIV counseling and testing to be provided by lay workers (occurring in 14 of the 23 countries surveyed), and allowing for multiple-month refills, rather than monthly, for ART for people in stable health (happening in eight countries).

“More countries need to shift policies to allow nurses to start people on treatment, and other health workers to monitor patients’ treatment so treatment can be available in every clinic, in every village, in every country struggling with HIV,” she said.

Although slow going, progress in some areas is improving, Lynch said. “Six countries changed their policies regarding ART administration to nurses and other clinicians in last year alone,” but more needs to be done. Four of the 23 countries surveyed require viral load testing before switching to second-line or further regimens, even though the technology is only widely available in four countries.

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