UNAIDS strategy: Speed HIV treatment coverage, address gaps to reach “15 by 15”

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UNAIDS2015Remember 3 by 5? The intended ambitiousness of that goal, to supply lifesaving antiretroviral treatment to three million of the people globally who needed it by 2005, as well as the failure to reach, it said as much about the impact of years of neglect as it did about the world’s desire to make up for it.

Now, more than a decade of donor funding,  action, science, and lessons from all of that have set the stage for 15 million of the people who are eligible for antiretroviral treatment according to the new World Health Organization HIV treatment guidelines, getting it by 2015, a document released Saturday by UNAIDS says. But the report notes, with only about 1,000 days between now and then, reaching that goal will mean making each one of those days count.

The document, Treatment 2015, gathers strategies based on clinical research, mathematical modelling and on-the-ground outcomes to lay out a framework for expanded treatment coverage, a critical step, authors say, on a path to the end of the epidemic.

The framework begins by acknowledging that reaching and sustaining the patients who will make up that 15 million is not achievable under the current moment, and will mean both accelerated and adapted approaches to testing and treating people worldwide for HIV.

UNAIDS2015DeathsAvertedIt means systems will need to adapt to people, rather than people adapting to systems, the framework says. It means gaps that keep services inaccessible to those who need them most must be closed, and missed populations reached. To get an idea of the impact that would have, consider the breadth the category of “missed populations” encompasses: children, men, refugees, people displaced within their own countries, people involved in commercial sex, men who have sex with men, other sexual minorities, including transgender women, and people who inject drugs. The barriers those populations face now, the framework notes range from peculiar prioritizing (children) to institutionalized neglect, hostility, denial of services, discriminatory laws (all of the rest).

Addressing those barriers while speeding testing and treatment access will come with moderately increased costs, the framework acknowledges, but the payoff of 15 million people on treatment will come with the bonus of a “healthier, more just and more prosperous” world. The investment, the document adds, will yield triple economic returns in productivity, preventing children from being orphaned, and averting the costs of treating illnesses from untreated HIV.

The framework cites modelling showing that acting quickly on the expanded WHO guidelines will greatly lower future treatment costs by preventing new infections. It cites findings in KwaZulu-Natal showing 30-40 percent treatment coverage reduced HIV acquisition risks 38 percent compared to communities where only 10 percent of those who need treatment receive it.

As “proof of concept” the report cites the increasing number of countries — Malawi, Botswana, Namibia and Zambia among them — that have reached the “tipping point” at which numbers of people newly infected are surpassed by numbers receiving treatment, or as the report puts it, “when the response begins to outpace the epidemic itself.” The roles of government, civil society, science, monitoring and evaluation are some of the ingredients of their success. By contrast, the report notes, countries that have failed to overcome obstacles to accelerated HIV testing and treatment have continued to see their epidemics expand.

For the framework’s specific recommendations, which include addressing licensing and intellectual property issues that inflate drug prices, integrating services, strengthening community systems including by supporting community health workers, download the report here



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