Thursday, 15 March 2012

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The long climb to universal access

A WHO Progress Report on HIV/AIDS finds that the price for second-line treatment is unaffordable, that the vast majority of pregnant women in need of PMTCT services are not receiving them, and that the global coverage of HIV testing and counselling remains unsatisfactorily low.

‘Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector - Progress Report, April 2007’ is the first in a series of proposed annual reports, which the World Health Organisation is committed to preparing in its attempt to monitor and evaluate the global health sector response in scaling up towards universal access. This commitment was made at the World Health Assembly in May 2006 in the context of the Millennium Development Goals of “universal access to comprehensive prevention programmes, treatment, care and support” by 2010.

The term “access” in this report is used in its broad sense, to measure three dimensions of key health sector interventions, viz, availability (in terms of physical, economic and socio-cultural access) of services that meet a minimum standard of quality; coverage (the proportion of a population needing an intervention who receive it); and impact (reduced new infection rates or improvements in survival). The data presented in this report focuses on the coverage and impact of interventions.

The ‘3 by 5’ initiative highlighted the value of target-setting in driving important public health initiatives and the need for simplified and standardised approaches to service delivery in many low-income settings. It also revealed various significant obstacles to the further scale-up of HIV prevention, treatment and care. Based on these learnings, WHO established priorities for supporting countries on the basis of Strategic Directions, representing critical areas where the health sector must invest.

Building on the ‘3 by 5’ progress reports published by WHO and UNAIDS in 2004, 2005 and 2006, this report addresses progress in scaling up the following health sector interventions, viz, antiretroviral therapy, prevention of mother-to-child transmission of HIV (PMTCT), HIV testing and counselling, interventions for injecting drug users (IDUs), control of sexually transmitted infections (STIs) to prevent HIV transmission and surveillance of the HIV/AIDS epidemic.

By December 2006 it was estimated that 2,015,000 (1.8-2.2 million) people living with HIV/AIDS were receiving treatment in low- and middle-income countries, representing 28% of the estimated 7.1 million people in need. Access varies tremendously between countries and regions of the world, with North Africa and the Middle East having the lowest estimated coverage of 6%. Coverage for children still lags behind the total estimated antiretroviral treatment coverage of 28% in low- and middle-income countries, with sub-Saharan Africa having the lowest treatment coverage for children of any region. Globally, injecting drug users (IDUs) continue to have poor and inequitable access to antiretroviral treatment, particularly in Eastern Europe. While the prices of most first-line antiretroviral drugs decreased substantially from 2003 to 2006, the average prices for second-line regimens remain unaffordably high in low- and middle-income countries, where few or no pre-qualified generic alternatives are available.

The vast majority of pregnant women in need of PMTCT services are not receiving them. In 2005, an estimated coverage rate of only 11% of pregnant women estimated to be living with HIV received antiretroviral prophylaxis for PMTCT.

The global coverage of HIV testing and counselling remains unsatisfactorily low, according to the report. Data on the number of people living with HIV/AIDS who know their HIV-positive status is even more limited. In 2005, in more than 70 surveyed low- and middle-income countries, only 10% of pregnant women had received an HIV test. In countries with a generalised HIV epidemic, only 13% of all TB patients were tested for HIV in 2005. Though the proportion of IDUs receiving some type of prevention service has increased in the last few years, the coverage of prevention interventions for IDUs is still very low compared to the size of the global IDU population. The prevalence of certain major sexually transmitted infections has fallen in many parts of the world, while there appears to have been an absolute increase in the incidence of herpes simplex virus type 2 infection.

The report discusses progress in setting country-level targets, provides conclusions arising from the data, and indicates steps that must be taken in the key intervention areas so as to accelerate progress towards universal access. Finally, the report highlights progress to date and key challenges in scaling up priority health sector interventions for HIV/AIDS in seven countries that have a particularly high burden of HIV.

From 2008 onwards, the reports will provide data on the scale-up of other selected interventions, including prevention for at-risk populations such as sex workers, men who have sex with men, and prisoners, as well as on progress in overcoming health system barriers to achieving universal access. Future reports will also consider human resources, drug procurement and supply management systems, health information systems, blood safety, and approaches to health financing.

Click here to read the full report

InfoChange News & Features, April 2008

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