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Progress on Global Access to HIV Antiretroviral Therapy: a Report on “3 by 5” and Beyond, March 2006

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Progress on Global Access to HIV Antiretroviral Therapy: a Report on “3 by 5” and Beyond, March 2006 Progress on Global Access to HIV Antiretroviral Therapy A Report on 3 by 5 and Beyond March 2006 WHO Library Cataloguing-in-Publication Data: Progress on global access to HIV antiretroviral therapy: a report on “3 by 5” and beyond, March 2006. 1.HIV infections - drug therapy. 2.Acquired immunodefi ciency syndrome - drug therapy. 3.Anti-retroviral agents - supply and distribution. 4.Antiretroviral therapy, Highly active. 5.Program evaluation. 6.Treat 3 Million by 2005 Initiative. I.World Health Organization. II.UNAIDS. ISBN 92 4 159413 6 (NLM classifi cation: WC 503.2) ISBN 978 92 4 159413 4 © World Health Organization 2006 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifi c companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Switzerland A REPORT ON “3 BY 5” AND BEYOND March 2006 Contents Foreword ............................................................................................................................................................................................................................5 Executive summary ..................................................................................................................................................................................................7 Introduction .................................................................................................................................................................................................................. 15 Part 1. Global progress 2003–2005 1. Scaling up access to HIV treatment ................................................................................................................................................... 19 1.1 Number of people receiving treatment ........................................................................................................................................... 19 1.2 Who is getting treatment? ...................................................................................................................................................................... 21 1.3 Expansion of treatment sites ................................................................................................................................................................ 24 1.4 Treatment outcomes ................................................................................................................................................................................... 26 1.5 Drug procurement and supply systems ........................................................................................................................................ 26 1.6 Prices of drugs and other commodities ........................................................................................................................................29 2. Strengthening health systems ................................................................................................................................................................32 2.1 Human resource capacity .......................................................................................................................................................................32 2.2 Using existing entry points .....................................................................................................................................................................33 3. Political commitment and partnerships .........................................................................................................................................39 3.1 Political and fi nancial commitment ...................................................................................................................................................39 3.2 Partnership and coordination............................................................................................................................................................... 42 Part 2. Towards universal access 1. Building on lessons learned ......................................................................................................................................................................49 1.1 Targets mobilize commitment and action .....................................................................................................................................49 1.2 Policy reforms maximize programme effectiveness .............................................................................................................49 1.3 Key operational approaches facilitate scale-up ....................................................................................................................... 51 1.4 Persistent challenges must be overcome ....................................................................................................................................55 2. Moving the agenda forward ......................................................................................................................................................................65 3. Supporting the health sector response ..........................................................................................................................................66 Conclusion ....................................................................................................................................................................................................................69 Annex 1. Estimated number of people receiving antiretroviral therapy, people needing antiretroviral therapy, percentage coverage and numbers of antiretroviral therapy sites in low- and middle-income countries ........... 71 Annex 2. Data by WHO region and methods used in estimating the number of people receiving and needing antiretroviral therapy ................................................................................................................................................................... 77 Annex 3. The “3 by 5” focus countries ........................................................................................................................................................80 3 4 A REPORT ON “3 BY 5” AND BEYOND March 2006 Foreword The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) jointly launched the “3 by 5” strategy in December 2003, with the objective of helping low- and middle-income countries provide treatment to 3 million people living with HIV/AIDS by the end of 2005. The “3 by 5” target challenged governments, foundations, corporations and the United Nations system to scale up access to antiretroviral therapy as quickly and effectively as possible. The objective was both to deliver drugs and to build health care capacity by mobilizing donor country and national resources, training health care workers, educating communities, expanding testing and counselling and scaling up HIV prevention. The “3 by 5” target has not been met on time. However, the ongoing effort to expand access to antiretroviral therapy has brought about positive change and has paved the way for far greater advances towards the ultimate goal of universal access to HIV treatment and care. In two years, the number of people receiving antiretroviral therapy in low-and middle-income countries has more than tripled, and access to antiretroviral therapy in the world’s hardest-hit region, sub-Saharan Africa, has increased by more than 800%. Today, more than 1.3 million people in low- and middle-income countries are receiving treatment. In 2005, between 250 000 and 350 000 deaths were averted because treatment is available. Every year of life gained provides greater economic stability, food security and educational opportunities for the families of those living with HIV/AIDS and strengthens their wider communities. What we have learned since the initiation of this effort is both sobering and encouraging. First, the global public health
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