E-DRUG: 3x5 progress report December 2004
[So now we have 0.7 x 5, not 3 x 5 as needed...
Anyway, a lifesaver for many hundredthousands. Full report at
Wilbert Bannenberg, moderator]
In the second half of 2004, the number of people on antiretroviral (ARV)
therapy in developing and transitional
countries increased dramatically from 440 000 to an estimated 700 000. This fi
gure represents about 12%
of the approximately 5.8 million people currently needing treatment in
developing and transitional countries
and includes people receiving ARV therapy supported by the Global Fund to Fight
AIDS, Tuberculosis and
Malaria, the United States Presidents Emergency Plan for AIDS Relief, the
World Bank and other partners.
In sub-Saharan Africa, the number of people on treatment doubled from 150 000
to 310 000 in just six
months. In Botswana, Kenya, South Africa, Uganda and Zambia the number of
people receiving treatment
increased by more than 10 000 in each country. Botswana, Namibia and Uganda now
have an estimated
ARV therapy coverage that exceeds one quarter of all people needing treatment,
and 13 countries in the
region have exceeded 10% coverage. This region now has well over 700 sites that
can deliver ARV therapy.
In East, South and South-East Asia, 100 000 people were on treatment by the end
of 2004, twice the number
reported six months previously. Thailand is leading the way, expanding
treatment access to all districts with
more than 900 ARV therapy facilities and starting more than 3000 people on
treatment every month.
In Latin America and the Caribbean, access to ARV therapy continued to improve.
Brazil has led the way
by providing access to ARV therapy for its entire population, but nine more
countries also have estimated
coverage rates exceeding 50%. Progress in Eastern Europe, Central Asia, North
Africa and the Middle East
has generally been much slower.
Initial data show that treatment success rates in developing countries are just
as good as those in affl uent
industrialized countries. Adherence to regimens is as high as 90% and treatment
benefi ts to individuals are
dramatic, with survival rates exceeding 90% after one year and 80% after two
years of ARV therapy.
A key to the rapid expansion has been the courageous public commitment by
governments in affected
countries, making HIV/AIDS interventions a fi scal priority and a consistent
theme of public outreach. Led
by effective and energetic national AIDS councils, many countries are exceeding
their individual targets,
showing that the global 3 by 5 target can be attained.
In several countries, dramatic improvements in treatment access have followed
an increase in the number of
locations for delivering ARV therapy. Generally, the numbers of women on
therapy have increased as rapidly
as those for men, but treatment for children is still a neglected issue.
Over the past 12 months, a strong international movement has gathered behind
the 3 by 5 target.
Partnerships, both within countries and globally, are the main engines of
HIV/AIDS treatment scale-up. At
the country level, response has been unprecedented from both the public and the
private sectors. Building
on ongoing work in many affected countries, the Global Fund to Fight AIDS,
Tuberculosis and Malaria, the
United States Presidents Emergency Plan for AIDS Relief and the World Bank
have all played a critical role
in making scale-up possible. Their large new fi nancial commitments have
greatly facilitated activities at the
country level, augmented response of other donors and in general boosted
The building blocks of ARV therapy scale-up
In many locations, several key building blocks of ARV therapy programmes have
been put into place. These
include expanding access to HIV testing and counselling; integrating ARV
therapy and tuberculosis programmes;
improving access and integrating care and support services; preventing
mother-to-child HIV transmission;
providing drugs and diagnostics; training for professionals, community members
and people living with
HIV/AIDS; developing systems for tracking and monitoring the people receiving
treatment; and institutionalizing
operational research to translate hard-won experience into evidence-based
programme design adapted to
local conditions. The scaling up of ARV therapy, if managed wisely, can lead to
the strengthening of both HIV
prevention programmes and the broader health system.
During the second half of 2004, an additional 40 000 to 50 000 people initiated
treatment each month
worldwide. Nevertheless, there are enormous barriers to reaching the target in
2005. Many of the advances
have been geographically uneven: critical building blocks are still missing in
far too many areas of highburden
Political will demonstrated at the highest possible level in any individual
country will be decisive in determining
whether it reaches its target. We can be encouraged by the fl exibility and
creativity already displayed by
major donors in making money move to where it is needed most, but their efforts
must now be taken to the
next level. Given present system costs, at least US$ 2 billion in sustained
additional funding from national
governments and external funders will be necessary to provide access to ARV
therapy for approximately
2.3 million people.
The resource gap is only one of many diffi cult obstacles that confront us.
Cost of ARV medicines to countries
and individuals is an area of particular concern, as is the geographical
distribution of services related to
HIV/AIDS and human resources. There is still a critical need to improve the
infrastructure for delivery of
care and treatment. Organizations working in the fi eld of HIV/AIDS must ensure
that their efforts offer real
solutions to the very real problems countries will face. However, progress in
2004 has laid the foundations
for an extraordinary push to reach the 3 by 5 target by the end of 2005.