USIS Washington File - April 5, 2006
Cheryl Pellerin, Washington File Staff Writer

Charting the final progress of the "3 by 5" strategy to expand access to HIV therapy in the developing world, the report - Progress on Global Access to HIV Antiretroviral Therapy - also says lessons learned in the last two years lay a foundation for global efforts now under way to provide universal access to HIV treatment by 2010.

Progress in treatment scale-up, while substantial, was less than initially hoped, according to a March 28 UNAIDS press release.

But the report notes that treatment access expanded in every region of the world during the "3 by 5" initiative, with about 50,000 people beginning ART every month in the past year.

Launched by WHO and UNAIDS on World AIDS Day in 2003, 3 by 5 aimed to provide treatment to 3 million people in low- and middle-income countries by the end of 2005.

The ambitious target was based on a 2001 analysis of what could be accomplished with an optimal combination of funding, technical capacity building, health systems strengthening and political will and cooperation.

The initiative confirmed that HIV treatment can be delivered effectively in a variety of health systems, including those in poor countries and rural settings, and that large-scale ART access is achievable and increasingly affordable.

SCALING UP TREATMENT

Sub-Saharan Africa, the region most severely affected, led the scale-up effort. The number of people receiving HIV treatment there increased more than eightfold, to 810,000 from 100,000 in the two-year period.

By the end of 2005, more than half of all people receiving HIV treatment in low- and middle-income countries lived in sub-Saharan Africa, up from one-quarter two years earlier.

"Two years ago, political support and resources for the rapid scale-up of HIV treatment were very limited," said WHO Director-General Lee Jong-wook.

"Today," he added, "3 by 5 has helped to mobilize political and financial commitment to achieving much broader access to treatment. This fundamental change in expectations is transforming our hopes of tackling not just HIV/AIDS, but other diseases as well."

In July 2005, the Group of Eight (G8) nations (Canada, France, Germany, Italy, Japan, Russia, the United Kingdom and the United States) endorsed a goal of working with WHO and UNAIDS to develop an essential package of HIV prevention, treatment and care with the aim of moving as close as possible to universal access to treatment by 2010.

The new WHO/UNAIDS report outlines steps that must be taken to continue and expand treatment scale up toward this goal.

Countries in every region of the world made substantial gains during the 3 by 5 period in closing the gap between those in need of treatment and those receiving it.

The number of public-sector treatment sites in low- and middle-income countries increased from fewer than 500 providing ART to more than 5,100 operational treatment sites by the end of 2005.

A recent survey showed, for example, that the number of treatment sites in Malawi increased from three in early 2003 to 60, and in Zambia, from three to more than 110 facilities in just more than two years.

MEETING TARGETS

Globally, 18 developing countries met the 3 by 5 target of providing treatment to at least half of those in need by the end of 2005, and are now focusing their efforts on moving toward universal access to treatment.

Other countries fell short of this target, but lessons learned in expanding treatment access and overcoming critical weaknesses in health systems are informing new initiatives to further scale up HIV prevention, treatment and care services.

Increased ART availability prevented an estimated 250,000-350,000 premature deaths in the developing world in 2005 alone.

Between 2003 and 2005, global expenditure on AIDS increased from $4.7 billion to an estimated $8.3 billion.

Significant proportions of this funding were provided by the U.S. PresidentÆs Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, TB and Malaria and the World Bank.

During the same period, the price of first-line treatment decreased by between 37 percent and 53 percent, depending on the regimen used.

PURSUING UNIVERSAL ACCESS

Important advances in HIV treatment access have been achieved in the past two years, but the report also acknowledges that, despite the efforts of many partners and significant funding from a number of donors, the 3 by 5 strategy fell short of its ambitions.

Obstacles to scaling up HIV treatment and prevention highlighted in the report include poorly harmonized partnerships; constraints on the procurement and supply of drugs, diagnostics and other commodities; strained human resources capacity and other weaknesses in health systems; difficulties in ensuring equitable access; and lack of standardized systems for managing programs and monitoring progress.

"The past two years have provided a wealth of experience and information on which we must now continue to build," said WHO HIV/AIDS Department Director Kevin De Cock.

"We intend to utilize this knowledge to focus future efforts on overcoming persistent challenges and obstacles. It is particularly important that scaling-up HIV prevention, treatment and care services contributes to strengthening of health systems overall."

The new report says WHO and UNAIDS will continue to build on lessons learned, and on the priorities, strategies and partnerships of 3 by 5 in accelerating the AIDS response.

UNAIDS is facilitating the development of nationally agreed plans and targets to move toward universal access to HIV prevention, treatment, care and support.

WHO's contribution to realizing universal access will be based on a set of priority interventions in five strategic directions that significantly influence the epidemic in different epidemiological contexts:

* Enabling people to know their HIV status through HIV testing and counseling,

* Accelerating the scale up of treatment and care,

* Maximizing the health sector's contribution to HIV prevention,

* Investing in strategic information to guide a more effective response, and

* Strengthening and expanding health systems.

The press release and the full report in French and English are available on the World Health Organization Web site.

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