taking the pulse: global update on the health sector response to hiv, 2014 dr gundo weiler
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Taking the Pulse: Global Update on the Health Sector Response to HIV, 2014 Dr Gundo Weiler Coordinator Strategic Information HIV Department World Health Organization WHO Satellite at AIDS2014, 20 July 2014. Global Health Sector Strategy on HIV/AIDS 2011-2015 - PowerPoint PPT PresentationTRANSCRIPT
Taking the Pulse:
Global Update on the Health Sector Response to HIV, 2014Dr Gundo Weiler
Coordinator Strategic Information
HIV Department
World Health Organization
WHO Satellite at AIDS2014, 20 July 2014
Global Health Sector Strategy on HIV/AIDS 2011-2015- a new health sector agenda for HIV/AIDS
Leverage broader health outcomes through HIV/AIDS responses
Reduce vulnerabilities and remove structural access barriers
Build strong and sustainablehealth systems
Optimize HIV prevention, diagnosis, treatment and care ❷
❸
❶
❹
Gauging recent progress in the global HIV response
2.1 million HIV infections ▼ 15%
240 000 HIV infections in children ▼ 40%
1.5 million HIV related deaths ▼ 25%
320 000 TB-related deaths in PLWHA* ▼ 36%** *2012 ** 2004-2012
[1.9 – 2.5 million]
[1.4 – 1.7 million]
[210 000 – 280 000]
[300 000 – 340 000]
2013 2009-2013
Outline
01 | Prevention, diagnosis, treatment and care
ART
PMTCT
Prevention
02 | Service integration
03 | Systems strengthening
04 | Removing structural barriers
Methodology
Global AIDS Response Progress Reporting (GARPR)
• Annual reporting of programme data by countries (MoH, NAPs), electronic platform managed by UNAIDS, validated jointly by WHO, UNICEF, UNAIDS
• By June 2014, 131 out of 144 low- and middle income countries provided ART data, representing 99% of estimated total number of people on ART at end of 2013
Country policies and practices
• Real-time tracking of implementation of HIV health sector policies in practices in 58 focus countries, including UBRAF high impact countries and Global Plan countries
• Country submission through GARPR and validation/completion by WHO in-country staff.
12,9 million people on ART at the end of 2013 globally. 11,7 in low-and middle income countries - 2 million more than at the end of 2012
Actual and projected numbers of people receiving antiretroviral therapy in low-and middle-income countries, and by WHO Region, 2003–2015
Source: 2014 Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS).
Catalyse HIV treatment, care and support
Africa, with most people living with HIV, continues to drive global scale-up, but low-coverage Regions are catching up
Catalyse HIV treatment, care and support
Total: 11.7 million in LMIC36%
788 00044%
9 100 00037%
28 00010%
254 00022%
402 00032%
1 100 00033%
Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates
Global scale-up driven by large increases in ART for adults
Adults
9,0 m
10,9 m+ 21%
> 1 in 3 adults with HIV on ART (37%)
Catalyse HIV treatment, care and support
Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates
The gap between access to ART for children and adults continues to widen
Adults
Children
9,0 m
740 k
10,9 m
640 k
+ 21%
+ 15%1 in 4 children with HIV on ART (23%)
Catalyse HIV treatment, care and support
> 1 in 3 adults with HIV on ART (37%)
Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates
HIV has become the 2nd biggest cause of death for adolescents globally
Catalyse HIV treatment, care and support
Source: Health of the world’s adolescent, WHO 2014
Access to ART for people who inject drugs remains insufficient, the example of Eastern Europe
PWID among all
PLWHA
PWID among all on ART
People who inject drugs as aproportion of all people living with HIVwith a known transmission route and The proportion of people who inject drugs Who received antiretroviral therapy in reporting countries, WHO European Region
Catalyse HIV treatment, care and support
Outline
01 | Prevention, diagnosis, treatment and care
ART
PMTCT
Prevention
02 | Service integration
03 | Systems strengthening
04 | Removing structural barriers
05 | Looking ahead
Close to 1 million pregnant women received ARVs, 500,000 still being missed
Eliminate new HIV infections in children
2005 2006 2007 2008 2009 2010 2011 2012 2013 0
200 000
400 000
600 000
800 000
1 000 000
1 200 000
1 400 000
1 600 000
1 800 000
2 000 000
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 640 0001 540 000
1 450 000
220 000
730 000
966 000
13%
47%
67%
Number of pregnant women living with HIV needing ARV medicines for PMTCTRangesSeries3Number of pregnant women living with HIV receiving any ARV medicines for PMTCTPercentage coverage
Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates
Source: Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS) and 2013 UNAIDS estimates.
Reaching the global target will depend on progress in some high burden countries with persisting low coverage
Democratic Republic of the Congo
Ethiopia
Cameroon
Malawi
Zimbabwe
Zambia
Kenya
Mozambique
United Republic of Tanzania
Uganda
Nigeria
South Africa
0 50 000 100 000 150 000 200 000 250 000 300 000
33%55%61%
79%78%
76%63%
84%73%
75%27%
90%
Number of pregnant women living with HIV receiving ART medicines for PMTCT (Option A, B and B+)Total number of pregnant women living with HIV (all needing PMTCT ARVs)
Eliminate new HIV infections in children
Tanzania
DR of the Congo
Eliminate new HIV infections in children
Steady increase in roll-out of Early Infant Diagnosis, but still too few exposed children tested
2011 20130%
10%20%30%40%50%60%70%80%90%
100%
34% 43%
Pooled coverage of EID in 88 countries with data from 2011 and 2013
Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS)
Outline
01 | Prevention, diagnosis, treatment and care
ART
PMTCT
Prevention
02 | Service integration
03 | Systems strengthening
04 | Removing structural barriers
05 | Looking ahead
Key populations are disproportionally affected by HIV, and disturbing news on outbreaks across all regions
Average HIV prevalence in key population surveys and general population
Invigorate HIV Prevention
Source: Unpublished literature review based on 88 country studies, 2007-2013
SW MSM TG PWID0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
1.00% 1.20% 0.60% 0.70%
23.00%
16.00%
23.00%
19.00%
General population prevalenceKey population prevalence
Sex worker
Men who havesex with men
Transgenderpeople
People whoinject drugs
But still glaring gaps in addressing the needs of key populations in national HIV plans
MSM
Transge
nder people
Sex w
orkers
PWID
Prisoners
0%
20%
40%
60%
80%
100%
71%
28%
62%40% 52%
29%
72%
38%60% 48%
not addressedaddressed
Percentage of 58 WHO HIV Focal Countries with explicit reference to specific key populations in their national HIV/AIDS Plan, June 2014
Invigorate HIV Prevention
Invigorate HIV Prevention
VMMC increased by 50% in 2013 to a total of 5.8 million, but its full potential is far from being exhausted
Outline
01 | Prevention, diagnosis, treatment and care
ART
PMTCT
Prevention
02 | Service integration
03 | Systems strengthening
04 | Removing structural barriers
05 | Looking ahead
Accelerating increase in ART coverage among notified TB patients to 70%Percentage of people coinfected with HIV and notified TB who initiated ART, 2007–2013
Service Integration
Source: provisional data from the Global Tuberculosis Programme Database, June 2014
85% of all ANC attendees were tested for syphilis - countries are targeting dual elimination
Service Integration
Percentage of antenatal care attendees tested for syphilis at first visit, 2012
Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS)
HIV is supporting an emerging hepatitis agenda
HBV HCV testing HBV vaccination HCV treatment0%5%
10%15%20%25%30%35%40%45% 41%
21%
14%
Service Integration
Share among 58 WHO HIV focus countries offering hepatitis services in ART clinics, June 2014
Source: WHO HIV Country Intelligence Database, June 2014
Outline
01 | Prevention, diagnosis, treatment and care
ART
PMTCT
Prevention
02 | Service integration
03 | Systems strengthening
04 | Removing structural barriers
05 | Looking ahead
Prices continue to decrease, but stockouts remain of concern
Median prices of WHO-preferred first-line regimens per person per year, in US dollars, in low-and middle-income countries, 2004–2013
Systems Integration
In multiple countries laws, regulations or policies exist that can hinder service provision for key populations
Human Rights and Access Barriers
47%
53%
43%
MSMSexworkers
PWID
Source: GARPR 2013 – “Countries reporting existence of laws, regulations or policies that can pose obstacles to effective HIV prevention, treatment, care and support services for key populations”
Outline
01 | Prevention, diagnosis, treatment and care
ART
PMTCT
Prevention
02 | Service integration
03 | Systems strengthening
04 | Removing structural barriers
05 | Looking ahead
Rapid uptake of 2013 ARV guidelines increases eligibility
ART in liver disease
ART in SD couples
PMTCT Option B+
Paediatic ART <5 years
Adult initiation <CD 500
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
40%
48%
45%
39%
52%
Percentage of 58 WHO HIV Focal Countries with confirmed adoption of select WHO 2013 ARV recommendations, June 2014
_
* or 75% of 22 EMTCT Global Plan countries
*
Source: WHO HIV Country Intelligence Database, June 2014
Ending the AIDS epidemic by 2030
Source: UNAIDS estimates (2014), Gap report
Child – adult coverage gap is widening
Rapid uptake of new guidance, innovation is driving country responses
New eligibility criteria call for new ambitious treatment targets
Conclusions: Main figures and messages
12.9 million on ART globally, record 2 million increase in 2013
740 000 children on ART, only 15% more than in 2012
40-50% of countries have adopted 2013 ARV guidelines
HIV response blazes the trail for universal health coverage
Consolidation around integrated [HIV] service packages
Failure in reaching key populations
Since 2009, 25% drop in mortality, but only 15% drop in incidence
Acknowledgements• Countries: Ministries of Health and National AIDS Programmes from 181 countries• WHO: Andrew Ball, Txema Calleja, Michel Beusenberg, Chika Hayashi, Theresa
Babovic (cons.), Hein Marais (cons.), Isabel Bergeri, Gottfried Hirnschall, Meg Doherty, Rachel Baggaley, Jos Perriens, Marco Vitoria, Nathan Shaffer, Vincent Habiyambere, Boniface Dongmo, Eyerusalem Negussie, Martina Penazzato, Tunga Namjilsuren, Haileyesus Getahun, Annabel Baddeley, Emil Asamoah Odei, Frank Lule, Ying-Ru Lo, Dongbao Yu, Amaya Maw, Massimo Ghidinelli, Monica Alonso, Gabriele Riedner, Hamida Khattabi, Martin Donoghoe, Irina Eramova, Annemarie Stengaard
• UN organizations: Peter Ghys, Mary Mahy (UNAIDS); Craig McClure, Chewe Luo, Priscilla Idele, Rosalind Carter (UNICEF)
• Partners: Lara Stabinski (OGAC); Laura Porter, John Aberle-Grass (CDC); Chris Duncombe (BMGF); Alvaro Bermejo, Gitau Mburu (AIDS Alliance); Asia Russell (HealthGAP); Tony Harries (Union); Ade Fakoya (GFATM); Mark Harrington (TAG); Vincent Wong (USAID); Tim Hallet (Imperial College); Tsehaynesh Messele (ASLM)