Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector Preventing HIV Transmission from Mother to Child
Total Page：16
File Type：pdf, Size：1020Kb
For more information, contact: TOWARDS UNIVERSAL ACCESS World Health Organization Department of HIV/AIDS ISBN 978 92 4 159539 1 Avenue Appia 20 Scaling up priority HIV/AIDS interventions 1211 Geneva 27 Switzerland in the health sector E-mail: [email protected] Progress Report, April 2007 www.who.int/hiv TOWARDS UNIVERSAL ACCESS Scaling up priority HIV/AIDS interventions in the health sector Progress Report, April 2007 WHO Library Cataloguing-in-Publication Data Towards universal access : scaling up priority HIV/AIDS interventions in the health sector : progress report, April 2007. “World Health Organization, UNAIDS, UNICEF”. 1.Acquired immunodeficiency syndrome - prevention and control. 2.HIV infections - prevention and control. 3.Acquired immunodeficiency syndrome – therapy. 4.HIV infections – therapy. 5.Health services accessibility. 6.Antiretroviral therapy, Highly active. 7.Disease transmission, Vertical - prevention and control. I.World Health Organization. II.UNAIDS. III.UNICEF. ISBN 978 92 4 159539 1 (NLM classification: WC 503.6) © World Health Organization 2007 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; e-mail: [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; e-mail: [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 specific 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 the World Health Organization 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 contents EXECUTIVE SUMMARY .......................................................................................................................................... 5 1. INTRODUCTION ...............................................................................................................................................11 2. SUMMARY OF GLOBAL PROGRESS IN PRIORITY INTERVENTION AREAS .............................................14 2.1 Antiretroviral therapy ...............................................................................................................................14 2.1.1 Coverage and availability of services ............................................................................................14 2.1.2 Equity of access to treatment: women, children and injecting drug users ....................................17 2.1.3 Drug prices ................................................................................................................................... 21 2.1.4 Treatment outcomes ......................................................................................................................24 2.1.5 Impact of treatment on HIV prevention ......................................................................................... 30 2.2 Preventing HIV transmission from mother to child ...............................................................................31 2.2.1 Coverage and availability of services ............................................................................................31 2. HIV testing and counselling ................................................................................................................... 35 2.3.1 Coverage and availability of services ........................................................................................... 35 2.3.2 Testing and counselling for pregnant women ............................................................................... 36 2.3.3 HIV testing and counselling for TB patients ...................................................................................37 2.4 Interventions for injecting drug users .................................................................................................. 38 2.5 The control of sexually transmitted infections to prevent HIV transmission .....................................41 2.6 Surveillance of the HIV/AIDS epidemic ................................................................................................. 43 2.7 Progress in setting targets for universal access ................................................................................. 44 . MAJOR CHALLENGES AHEAD ...................................................................................................................... 45 4. SUMMARY OF PROGRESS IN SELECTED HIGH-BURDEN COUNTRIES .................................................. 53 Annex 1 Estimated numbers of people receiving and needing antiretroviral therapy and percentage coverage in WHO Member States .............................................................................. 64 Annex 2 Reported adult males and females (15+) and children receiving antiretroviral therapy, estimated number of adults and children needing antiretroviral therapy, and percentage coverage in low- and middle-income countries .......................................................... 72 Annex Preventing mother-to-child transmission of HIV in low- and middle-income countries ......................... 82 EXECUTIVE SUMMARY At the June 2006 United Nations General Assembly High-Level Meeting on HIV/AIDS, United Nations Member States agreed to work towards the goal of “universal access to comprehensive prevention programmes, treatment, care and support” by 2010. Drawing on lessons from the scale-up of HIV interventions over the last few years, WHO, as the UNAIDS cosponsor responsible for the health sector response to HIV/AIDS, has established priorities for its technical work and support to countries on the basis of the following five Strategic Directions, each of which represents a critical area where the health sector must invest if significant progress is to be made towards achieving universal access. 1. Enabling people to know their HIV status. 2. Maximizing the health sector's contribution to HIV prevention. 3. Accelerating the scale-up of HIV/AIDS treatment and care. 4. Strengthening and expanding health systems. 5. Investing in strategic information to guide a more effective response. In this context, WHO undertook at the World Health Assembly in May 2006 to monitor and evaluate the global health sector response in scaling up towards universal access and to produce annual reports. This first report addresses progress in scaling up the following health sector interventions. • 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. • Surveillance of the HIV/AIDS epidemic. From 2008 onwards, the annual reports will provide data on the scale-up of other selected interventions and on progress in overcoming health system barriers to achieving universal access. Antiretroviral therapy Encouraging global trends continue in the scale-up of antiretroviral treatment. In 2006, almost 700 000 people received treatment for the first time. 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% (24%−34%) of the estimated 7.1 million (6.0−8.4 million) people in need. Sub-Saharan Africa is now estimated to have more than 1.3 million people on antiretroviral treatment, with coverage of 28% (24%−33%), whereas three years earlier there were 100 000 on treatment and coverage amounted to only 2%. Of the people now receiving antiretroviral treatment in low- and middle-income countries, 67% live in sub-Saharan Africa, whereas only 25% were doing so in late 2003. In East, South and South-East Asia, 280 000 (225 000−335 000) people are now on treatment and coverage is estimated at 19% (13%−28%), representing a fourfold increase in comparison with the end of 2003, when 70 000 were on treatment. Although Asia represents 21% (17%−25%) of global treatment need, only 14% (13%−15%) of people on treatment in low- and middle-income countries live in this region. 5 In Latin America and the Caribbean the number of people receiving treatment has increased gradually to 355 000 (315 000−395 000); only 210 000 were doing so at the end of 2003. While there are considerable variations between countries, the overall coverage of 72% (55%−96%) appears to be