E-drug: WHO 3x5 strategy on supplies management (cont'd)
World Health Organization and UNAIDS unveil plan to get 3 million
aids patients on treatment by 2005
Comprehensive Approach to HIV/AIDS Treatment and Prevention
New AIDS Medicine and Diagnostics Service Simple Treatment
Regimens Published Training Tens of Thousands of People to
Support AIDS Treatment and Prevention
1 December 2003 | GENEVA -- The World Health Organization
(WHO) and UNAIDS today release a detailed and concrete plan to
reach the 3 by 5 target of providing antiretroviral treatment to three
million people living with AIDS in developing countries and those in
transition by the end of 2005. This is a vital step towards the ultimate
goal of providing universal access to AIDS treatment to all those who
The 3 by 5 initiative complements the groundbreaking commitments
made by the United States under President Bush's HIV/AIDS
Initiatives ($15 billion dollars for an enhanced AIDS response), the
pathfinding work of NGOs (like MSF) and faith-based groups, the
efforts of pharmaceutical companies to reduce the prices of AIDS
treatment, the contribution of international foundations like the Bill
and Melinda Gates Foundation, the initiative and hard work of many
national and international agencies, and, critically, the courageous
contributions of nations increasing their people's access to AIDS
"Preventing and treating AIDS may be the toughest health
assignment the world has ever faced, but it is also the most urgent,"
said Dr Lee Jong-wook, Director-General of the World Health
Organization. "The lives of millions of people are at stake. This
strategy demands massive and unconventional efforts to make sure
they stay alive."
UNAIDS announced last week that 40 million people around the world
are infected with HIV, and that the global AIDS epidemic shows no
signs of abating. Five million people became infected with HIV
worldwide and 3 million died this year alone - that's 8,000 people
every day. WHO estimates that six million people worldwide are in
immediate need of AIDS treatment. This strategy outlines the steps
needed to deliver treatment to half of them within two years.
The strategy is a key element in a combined programme of
accelerating HIV/AIDS prevention and treatment. Much has already
been done by countries, by UNAIDS, the World Bank, foundations,
WHO and many other groups. After twenty years of fighting the
epidemic, it is now clear that a comprehensive approach to HIV/AIDS
must include prevention, treatment and care.
"The 3 by 5 framework is a plan for action by a broad alliance of
nations, institutions, and committed people, including those living with
HIV/AIDS", said Dr. Jack Chow, Assistant Director-General of WHO
for HIV/AIDS, Tuberculosis and Malaria. "We urge all concerned to
work to reach the 3 by 5 target as rapidly as possible."
Evidence and experience shows that rapidly increasing the availability
of antiretroviral treatment in line with 3 by 5 targets can lead to more
people knowing their HIV status and more openness about AIDS.
Individuals on effective treatment are also likely to be less infectious
and less able to spread the virus. Good treatment programmes will
make more people come forward for testing HIV/AIDS status.
Treatment can therefore contribute to the rapid acceleration of
Building on work done by UNAIDS, developing and donor countries,
NGOs and other multilateral agencies, WHO and UNAIDS are taking
another big step forward in the global movement to increase access
to prevention and treatment services.
"The lack of HIV treatment is without a doubt a global emergency,"
said Dr Peter Piot, UNAIDS Executive Director. "We firmly believe
that we stand no chance of halting this epidemic unless we
dramatically scale up access to HIV care. Treatment and prevention
are the two pillars of a truly effective comprehensive AIDS strategy."
3 by 5 Strategy
To reach the 3 by 5 target, WHO and UNAIDS will focus on five
Simplified, standardised tools to deliver antiretroviral therapy A new
service to ensure an effective, reliable supply of medicines and
diagnostics Rapid identification, dissemination and application of new
knowledge and successful strategies Urgent, sustained support for
countries Global leadership, strong partnership and advocacy
Simplified Treatment Recommended
The strategy has greatly simplified the recommendations for AIDS
treatment regimens. The number of such WHO-recommended
regimens has been cut to four from 35. All four are equally effective.
The selection of an individual regimen for a patient will be based on a
combination of individual needs, together with the availability and
suitability of a particular regimen in a country. The strategy also
recommends the use of quality-assured "fixed dose combinations" or
easy-to-use blister packs of medicine whenever they are available.
The aim is to ensure that all people living with AIDS, even in the
poorest settings, have access to treatment through this simplified
The strategy also includes the global AIDS Medicines and
Diagnostics Service (AMDS), which will ensure that poor countries
have access to quality medicines and diagnostic tools at the best
prices. The service, which will be operated by WHO, UNICEF and
other partners, will help countries to forecast and manage supply and
delivery of necessary products for the treatment and monitoring of
AIDS. Through the WHO Prequalification Project, AMDS will also
include a medicines and diagnostics evaluation component which will
ensure that manufacturers, products, procurement agencies and
laboratories meet international quality, safety and efficacy standards.
Another key element is the simplification of monitoring, so that
easy-to-use tests such as body weight and colour-scale blood tests
are used where more complicated and expensive tests for viral load
and white cell (CD4) count are not yet available. The simpler tests,
combined with clinical evaluations by adequately trained health
workers, can be effective in monitoring the progress of AIDS, the
effectiveness of treatment and its side effects.
Treatment Action in Countries Already Under Way
Antiretroviral therapy programmes can only be expanded if there is
coordinated, scaled-up action in countries, particularly those
hardest-hit by AIDS. Countries are at the heart of the 3 by 5 strategy
and will be the focus of all efforts to meet the 3 by 5 target. Many
countries have already demonstrated their commitment to this target.
Immediately following the declaration of a global AIDS treatment
emergency, more than 20 countries requested collaboration and input
from WHO, UNAIDS and other partners.
Teams have already travelled to Kenya, Burkina Faso, Malawi and
Zambia. Other teams have done preparatory work in Ukraine, India
and Sudan. In each case, the teams will be working with governments
to identify and help remove obstacles, so that antiretroviral medicines
can be provided quickly to the people who need them most. Many
other countries, including Russia and Djibouti, have also requested
Training of health workers is an urgent need in all countries involved.
Many of the countries with the highest numbers of people living with
HIV/AIDS have very few doctors or other trained health staff. Many of
these health workers have died as a result of untreated AIDS; others
have moved to seek better pay and job security in wealthier countries.
Thousands of community workers to be trained One of the most
innovative aspects of the 3 by 5 strategy is a method for urgently
training tens of thousands of community health workers to support the
delivery and monitoring of HIV/AIDS treatment. An intensive training
programme would enable these health workers to evaluate and
monitor patients, and make sure they receive and are taking their
The strategy acknowledges that the involvement of communities and
community workers is essential to the success of this initiative.
Significant evidence and experience shows that without strong
community support, people may have a more difficult time adhering to
their medical regimens. Also, community involvement is a critical
element of any successful HIV prevention strategy.
There is also good evidence that treatment can have an accelerating
effect on prevention efforts. "We know from experience that the
availability of treatment encourages people to learn their HIV status
and receive counselling," said Dr Paulo Teixeira, Director of the
HIV/AIDS Department at WHO. "We also know that the availability of
treatment reduces stigma for people living with AIDS. People living
with AIDS have a right to treatment and we must find a way to
One of the key elements of the strategy is "learning by doing". The
strategy unveiled today by WHO and UNAIDS addresses many of the
obstacles that have up to now prevented millions of people in poor
countries from accessing AIDS medicines. The strategy will evolve as
lessons learnt from implementing the strategy are identified and
Reaching the 3 by 5 target will require substantial new funding for
AIDS treatment from all sources - countries, donor governments and
multilateral funding agencies. WHO has estimated that the extra
funding required amounts to approximately $5.5 billion over the next
"We know what to do but what we urgently need now are the
resources to do it," said Dr Lee. We must waste no time in building
strong alliances immediately to implement this strategy. Three million
people are counting on it."
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