[Ip-health] New WHO AIDS treatment progress report

[Benjamin Krohmal]

In the 92 page report, there is only one reference to patent or IP:
"[India's] generic drug manufacturing industry also faces the
challenge of compliance
with international laws on intellectual property rights, including
that of supplying the domestic antiretroviral  drug
market with generic versions of products that are patented or for
which patents are pending."


report:
http://www.who.int/entity/hiv/mediacentre/
univeral_access_progress_report_en.pdf
statement:
http://www.who.int/mediacentre/news/releases/2007/pr16/en/index.html


Significant growth in access to HIV treatment in 2006

More efforts needed for universal access to services

17 APRIL 2007 | LONDON -- Access to antiretroviral therapy for
advanced HIV infection in low- and middle-income countries continued
to grow throughout 2006, with more than 2 million people living with
HIV/AIDS receiving treatment in December 2006, a 54% increase over
the 1.3 million people on treatment one year earlier in these
countries. These encouraging findings were released today in a new
report, =93Towards universal access: scaling up priority HIV/AIDS
interventions in the health sector,=94 published by WHO, the Joint
United Nations Programme on HIV/AIDS (UNAIDS) and UNICEF.

At the same time, the report details a number of key areas in which
efforts to scale up services are insufficient if the global goal of
moving towards =93universal access to comprehensive prevention
programmes, treatment, care and support=94 for HIV by 2010 is to be
achieved. For example, just 11% of HIV-positive pregnant women in
need of antiretrovirals (ARVs) to prevent mother-to-child
transmission of HIV (PMTCT) in low- and middle-income countries are
receiving them. Global coverage of HIV testing and counselling
remains unsatisfactorily low, as does coverage of prevention and
treatment interventions for injecting drug users. And while countries
committed themselves to setting targets for universal access by the
end of 2006, only 90 had provided data on these by that date.

=93The combined efforts of donors, affected nations, UN agencies and
public health authorities are providing substantial, ongoing progress
in access to HIV services,=94 said Dr Margaret Chan, Director-General,
WHO. =93Yet, in many ways we are still at the beginning of this
commitment. We need ambitious national programmes, much greater
global mobilization, and increased accountability if we are going to
succeed."

Progress in access to HIV treatment

The report shows that countries in every region of the world are
making substantial progress in increasing access to HIV treatment.
More than 1.3 million people in sub-Saharan Africa were receiving
treatment in December 2006, representing coverage of approximately
28% of those in need compared to just 2% in 2003. Coverage in other
regions varied, from 6% in North Africa and the Middle East, to 15%
in Eastern Europe and Central Asia and 72% in Latin America and the
Caribbean. Overall, while encouraging trends continue, just 28% of
the estimated 7.1 million people in need of treatment in all low- and
middle-income countries were receiving it in December 2006.

Funding provided by the United States President=92s Emergency Plan for
AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and
Malaria was supporting 1 265 000 individuals receiving treatment by
the end of 2006. The prices of most first-line ARVs decreased by
between 37% and 53% in low- and middle-income countries from 2003 to
2006, and by between 10% and 20% from 2005 to 2006.

=93The significant progress outlined in this report in scaling up
access to treatment is a positive step forward for many countries in
achieving their ambitious goals of universal access to HIV
prevention, treatment, care and support,=94 said Dr Peter Piot,
Executive Director of UNAIDS. =93However new data in the report also
shows that there is still a long way to go, particularly in the
widespread provision of treatment to prevent mother to child
transmission of HIV, which remains one of the simplest and cheapest
proven prevention methods available,=94 he added.

The number of children receiving treatment increased by 50% in the
past year, but from a very low base. In December 2006, only about 115
500 (15%) children of the 780 000 estimated to be in need of HIV
treatment had access to it. According to HIV/AIDS Director in WHO, Dr
Kevin De Cock, "urgent priorities are improving access to HIV
treatment for children, especially in sub-Saharan Africa, as well as
for injecting drug users everywhere". =93Access to HIV testing and
counselling, a critical entry point for both prevention and treatment
services, also needs to be broadened significantly if we are to come
near to reaching the targets for universal access by 2010," he added.

=93Children continue to be the missing face of the AIDS pandemic,=94 said
UNICEF Executive Director Ann M. Veneman, =93with too many children
still missing out on life-saving treatment and access to other
essential services.=94 In 2005, UNICEF, UNAIDS and other partners
launched the Unite for Children, Unite against AIDS campaign. It
targets four key areas:

     * prevention of mother to child transmission;
     * treatment of paediatric AIDS;
     * education programmes for prevention; and
     * support for orphans and vulnerable children.

Challenges and recommendations

Among the report=92s recommendations for improving the global AIDS
response are the following:

Increase efforts to accelerate the prevention, diagnosis and
treatment of HIV disease in children.

In addition to the need to increase treatment access, progress
remains unsatisfactory in the prevention and diagnosis of HIV disease
in children. The technical challenges of expanding services for
children have been considerable. New approaches to overcoming these,
such as the development of appropriate diagnostics and fixed-dose
paediatric drug formulations, need to be more widely explored and
accelerated.

Introduce a range of strategies to increase knowledge of HIV status.

Surveys in 12 high-burden countries in sub-Saharan Africa showed that
a median of just 12% of men and 10% of women in the general
population had been tested for HIV and received the results. While
client-initiated voluntary counselling and testing (VCT) is helping
people know their status, provider-initiated HIV testing and
counselling (PITC) in health-care settings is emerging as a key
additional strategy to expand access to HIV prevention, treatment and
care services. The conditions under which testing and counselling are
provided must also be improved in order to diminish obstacles to
uptake, such as fear of stigma and negative reactions to disclosure.

Accelerate scale-up of services to prevent mother-to-child
transmission of HIV (PMTCT).

More than 100 low- and middle-income countries have established PMTCT
programmes, yet only seven were reaching 40% or more of HIV-infected
pregnant women in 2005. In sub-Saharan Africa, where 85% of HIV-
infected pregnant women live, coverage in countries ranges from less
than 1% to 54%. Current efforts to prevent mother-to-child
transmission of HIV are far below what is required to meet the UN
target of reducing the proportion of children infected with HIV by
50% in 2010.

Improve access to services for most-at-risk populations, including
injecting drug users and men who have sex with men (MSM).

Injecting drug use is a major mode of HIV transmission in several
regions and is emerging as a concern in Africa. Adequate prevention,
treatment, and care services need to be provided to this population
if a significant impact is to be made on HIV transmission. Resurgent
transmission of HIV and other sexually transmitted infections in MSM
in industrialized countries needs to be countered, and prevention
needs of MSM in low- and middle-income countries addressed.

Invest in prevention for people living with HIV/AIDS.

Persons living with HIV can be the strongest advocates for HIV
prevention. Better follow-up is required of individuals diagnosed
with HIV in voluntary counselling and testing centres. The health
sector should provide a wider range of services and interventions to
help people with HIV/AIDS to maximize their health, prevent and treat
opportunistic and sexually transmitted infections, reduce the harms
associated with injecting drug use, and avoid passing HIV on to others.

Improve access for people living with HIV/AIDS to quality TB
prevention, diagnostic and treatment services.

Most cases of TB are preventable or curable. Nevertheless, almost 1
million people living with HIV will develop TB disease each year,
leading to nearly a quarter of a million avoidable TB deaths. Chronic
underinvestment and inadequate political commitment to TB control in
many countries of high HIV prevalence have resulted in high TB
incidence among people with HIV/AIDS and have contributed to the
development of TB drug resistance. The emergence of extensively drug-
resistant tuberculosis (XDR-TB) must now be urgently addressed
through increased coordination and availability of prevention,
diagnostic, and treatment services, and through comprehensive
infection control strategies.

Recognize male circumcision as an important additional HIV prevention
intervention.

Recent clinical trial data demonstrate a significant reduction in the
risk of heterosexually acquired HIV infection among circumcised men.
Male circumcision could have a major public health impact in
countries where HIV prevalence is high, transmission is predominantly
through heterosexual contact, and rates of male circumcision are low.
Such countries should urgently consider scaling up access to safe
male circumcision services. Key issues in implementation include the
quality and safety of services, cultural considerations, and
adherence to human rights principles in the provision of male
circumcision, including informed consent, confidentiality, and
absence of coercion.

Address concerns about longer-term financial sustainability.

Financial concerns, especially with reference to what will be
available from major multilateral and bilateral sources in the long
term, continue to limit the scope and rate of scale-up in many
countries and threaten long-term sustainability. While encouraging
reductions have occurred in the price of first-line regimens in most
low- and some middle-income countries, the demand for expensive
second-line regimens will continue to increase. Unless prices for
second-line regimens fall significantly, budgetary constraints may
put treatment programmes at risk.