towards universal access scaling up priority hiv/aids internventions in the health sector

Progress Report | April 20071 |

Towards Universal AccessScaling up priority HIV/AIDS internventions in

the health sector

Towards Universal AccessScaling up priority HIV/AIDS internventions in

the health sector

Progress Report, April 2007


Estimated number of people receiving and needing antiretroviral therapy, and percentage coverage in low- and middle income countries according to region, December 2006

Estimated number of people receiving and needing antiretroviral therapy, and percentage coverage in low- and middle income countries according to region, December 2006

Geographical RegionNumber of people receiving ARV

therapy

Estimated need

Coverage

Sub-Saharan Africa1 340 0004 800 00028%

Latin America and the Caribbean355 000 490 00072%

East, South and South-East Asia280 0001 500 00019%

Europe and Central Asia35 000 230 00015%

North Africa and the Middle East5 00077 0006%

Total2 015 000 [1.8 – 2.2 million]

7 100 000[6.0 – 8.4 million]

28%[24 – 34%]


Estimated number of children aged under 15 years receiving and needing antiretroviral therapy, and percentage coverage in low- and middle income countries according to region, December 2006

Estimated number of children aged under 15 years receiving and needing antiretroviral therapy, and percentage coverage in low- and middle income countries according to region, December 2006

Geographical regionEstimated number of

children receiving

antiretroviral therapy

Estimated need among children

Coverage

EstimateLow estimate

High estimate

EstimateLow estimate

Highestimate

Sub-Saharan Africa85 000680 000510 000890 00013%10%17%

Latin America and the Caribbean

15 50023 00016 00037 00067%42%97%

East, South and South-East Asia

13 30064 00032 000120 00021%11%42%

Europe and Central Asia

1 5007 5003 80014 00020%11%39%

North Africa and the Middle East

<10010 0004 40020 000<1%0%1%

TOTAL115 500780 000600 0001 000 00015%12%19%


Number of people receiving ARV therapy in low- and middle-income countries, 2002—2006

Number of people receiving ARV therapy in low- and middle-income countries, 2002—2006

end

2002

mid

-200

3en

d 20

03m

id-2

004

end

2004

mid

-200

5

end

2005

mid

-200

6en

d-20

06

0

200

400

600

800

1 000

1 200

1 400

1 600

1 800

2 000

Pe

op

le r

ec

eiv

ing

AR

V t

he

rap

y (

in t

ho

us

an

ds

)

North Africa and the Middle East

Europe and Central Asia

East, South and South-East Asia

Latin America and the Caribbean

Sub-Saharan Africa


Unmet need in low- and middle-income countries according to region, December 2006

Unmet need in low- and middle-income countries according to region, December 2006

0

500 000

1 000 000

1 500 000

2 000 000

2 500 000

3 000 000

3 500 000

4 000 000

4 500 000

5 000 000

Sub-SaharanAfrica

Latin Americaand the

Caribbean

East, South andSouth-East Asia

Europe andCentral Asia

North Africa andthe Middle East

Nu

mb

er o

f p

eop

leUnmet need ARVtherapyReceiving ARVtreatment in Dec 2006

68% of the total unmet need


The bar indicates the uncertainty range around the estimate.

Estimated antiretroviral therapy coverage of at least 28% in low- and middle-income countries, December 2006a

Estimated antiretroviral therapy coverage of at least 28% in low- and middle-income countries, December 2006a

25%

50%

75%

100%

Bot

swan

aC

osta

Ric

a

Cub

aC

ambo

dia

Tha

iland

Bra

zil

Chi

leA

rgen

tina

Mex

ico

Rw

anda

Guy

ana

Nam

ibia

Ven

ezue

la

Pan

ama

Par

agu

ay

Jam

aica

Gua

tem

ala

Uru

guay

Col

ombi

a

Per

uT

rinid

ad a

nd T

obag

o

Ken

ya

Mal

awi

Sw

azila

nd

Uga

nda

Mor

occo

Hon

dura

sB

urki

na F

aso

El S

alva

dor

Hai

ti

Ben

inD

omin

ican

Rep

ublic

Mal

i

Gab

on

Zam

bia

Sen

egal

Ecu

ador

Sou

th A

fric

a

Alg

eria

Leso

tho

Eth

iopi

aC

ôte

d'Iv

oire

AR

T c

ove

rag

e

a28% is the overall ART coverage for low-income and middle-income countries. Only countries with an estimated ART need of at least 1000 are included in this graph.


Fifteen low- income and middle- income countries with the highest estimated numbers of people receiving treatment, and corresponding estimated antiretroviral therapy coverages, December 2006

Fifteen low- income and middle- income countries with the highest estimated numbers of people receiving treatment, and corresponding estimated antiretroviral therapy coverages, December 2006


aThe estimated ART coverage is currently under review and will be adjusted, as appropriate, based on new data collected during 2006. Preliminary analysis suggests that numbers lie within these ranges .

0

50 000

100 000

150 000

200 000

250 000

300 000

350 000

400 000

South

Afri

caBra

zil

Kenya

Thaila

nd

Ugand

aIn

dia

Botsw

ana

Zambi

a

Mal

awi

Niger

ia

Ethiop

ia

Zimbab

we

Unite

d Rep

ublic

of T

anza

nia

Moz

ambi

que

Mex

ico

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Number of people on treatment

Percentage ART coverage

aa a


aOnly countries with an ART need among children of at least 1000 are included in this graph.


Low-income and middle-income countries with antiretroviral therapy coverages of at least 25% among children under 15, 2006a

Low-income and middle-income countries with antiretroviral therapy coverages of at least 25% among children under 15, 2006a

51%

71%

86%

94%

95%

34%

35%

>95%

>95%

0% 20% 40% 60% 80% 100%

Honduras

Rwanda

Guatemala

Namibia

Argentina

Cambodia

Botswana

Thailand

Brazil


Treatment access among injecting drug users (IDUs) in Eastern Europe, selected countries, 2004

Treatment access among injecting drug users (IDUs) in Eastern Europe, selected countries, 2004

0

10

20

30

40

50

60

70

80

90

100

Estonia

Latvia

Lithuan

ia

Republic

of M

oldova

Russi

an F

edera

tion

Ukrai

ne

Per

cen

tag

e

IDUs as % of people onART

IDUs as % of reported HIVcases


Percentages of men reporting symptoms of STIs in the last 12 months who sought care at a service provider with personnel trained in STI care,

2002-2005

Percentages of men reporting symptoms of STIs in the last 12 months who sought care at a service provider with personnel trained in STI care,

2002-2005

Source: Demographic and Health Surveys (DHS), MEASURE DHS

01020

30405060

7080

Burkin

a Fas

o 2

003

Camer

oon

2004

Gha

na 2

003

Kenya

2003

Moz

ambi

que

2003

Niger

ia 2

003

Ugand

a 200

4-05

Zambi

a 20

03

Viet N

am 2

005

Bolivi

a 200

3

Domin

ican

Repub

lic 2

002

Country and year of survey

Per

cen

tag

e


Probability of death in African children starting antiretroviral therapy (ART) according to age at ART initiation (n = 1195). KIDS-ART-LINC Collaboration, February 2007

Probability of death in African children starting antiretroviral therapy (ART) according to age at ART initiation (n = 1195). KIDS-ART-LINC Collaboration, February 2007

0.00

0.05

0.10

0.15

0.20

0.0 0.2 0.4 0.6 0.8

Time (years)

Pro

bab

ility

<12 months

12-35 months

36-59 months

≥5 years


Source: National AIDS Control Organization (NACO), Ministry of Health, India


Probability of death among people on antiretroviral therapy in four ART programmes in Côte d'Ivoire, Malawi and South Africa, February 2007

Probability of death among people on antiretroviral therapy in four ART programmes in Côte d'Ivoire, Malawi and South Africa, February 2007

Months since starting antiretroviral therapy

0 6 12 18 24

Cu

mu

lativ

em

ort

ality

(%)

0%

5%

10%

15%

Kaplan-Meier curves of probability of death in 7109 HIV-1-infected patients treated in four large ART programmes in Côte d'Ivoire, Malawi and South Africa. Results from individual clinics are shown in grey, combined estimates in blue. ART-LINC (ANRS/NIH) Collaboration, February 2007.


Institutional deaths per 100 000 population and programmatic data: patients currently receiving antiretroviral therapy and deaths on therapy, Botswana 1994-2005a

Institutional deaths per 100 000 population and programmatic data: patients currently receiving antiretroviral therapy and deaths on therapy, Botswana 1994-2005a

a2005 deaths annualized on basis of deaths until June 2005, reported by November 2005; ART programme data reported until September 2005.

3 515

10 858

30 600

45 120

0

100

200

300

400

500

600

700

1994 1996 1997 1999 2000 2001 2002 2003 2004 2005

Dea

ths

per

100

000

po

pu

lati

on

0

5 000

10 000

15 000

20 000

25 000

30 000

35 000

40 000

45 000

50 000

Peo

ple

cu

rren

tly

rece

ivin

g a

nti

retr

ovi

ral t

her

apy

Patients receiving antiretroviral therapy

Deaths of those on therapy

Deaths per 100 000 population

2002 estimated from mortality reports


Ten low-income and middle-income countries with the highest estimated numbers of HIV-infected pregnant women and corresponding percentages of HIV-infected pregnant women who received ARVs for PMTCT, 2005

Ten low-income and middle-income countries with the highest estimated numbers of HIV-infected pregnant women and corresponding percentages of HIV-infected pregnant women who received ARVs for PMTCT, 2005

0

50 000

100 000

150 000

200 000

250 000

300 000

350 000

400 000

450 000

South Africa

Nigeria

MozambiqueIndia

United Republic of TanzaniaUganda

Democratic Republic of th

e CongoKenya

ZimbabweZambia

Nu

mb

er

0%

5%

10%

15%

20%

25%

30%

35%

Co

vera

ge

Estimated number of HIV-infected pregnant women

% of pregnant women who received ARVs for PMTCT


Percentages of pregnant women who received an HIV test and percentages of HIV-infected pregnant women receiving ARVs for PMTCT, selected countries, 2005a

Percentages of pregnant women who received an HIV test and percentages of HIV-infected pregnant women receiving ARVs for PMTCT, selected countries, 2005a

aCountries with at least 40% of HIV-infected pregnant women who received ARVs for PMTCT are included in this graph (countries with less than 500 estimated HIV-infected pregnant women are not included). Countries are ranked by the numbers of HIV-infected pregnant women, i.e. Botswana has the highest number and Jamaica the lowest .

Source: UNICEF and WHO on behalf of the expanded Interagency Task Team on PMTCT, "A report card on the prevention of mother-to-child transmission of HIV and paediatric HIV care", 2006 (forthcoming).

Percentage of HIV-infected pregnant women who received ARVs for PMTCTc

Percentage of pregnant women who received an HIV testb


b Denominator is estimated number of pregnant women (15-49 years old) as of 2005.

c Denominator is estimated number of HIV-infected pregnant women (15-49 years old) as of 2005.

0%20%40%60%80%100%

Jamaica

Argentina

Ukraine

Russian Federation

Thailand

Brazil

Botsw ana

0% 20% 40% 60% 80% 100%

Jamaica

Argentina

Ukraine

Russian Federation

Thailand

Brazil

Botswana


Number of PMTCT sites in Rwanda, 1999-2006Number of PMTCT sites in Rwanda, 1999-2006

Source: Ministry of Health, Rwanda

1 2

3353

120

199 208221

0

50

100

150

200

250

1999 2000 2001 2002 2003 2004 2005 mid-06

Year

Nu

mb

er o

f si

tes


Selected PMTCT programme indicators, Rwanda, 2005Selected PMTCT programme indicators, Rwanda, 2005

Source: Ministry of Health, Rwanda

0

1 000

2 000

3 000

4 000

5 000

6 000

7 000

8 000

9 000

10 000

Pregna

nt w

omen

iden

tified

HIV

-pos

itive

Mat

ernal

ARV pro

phyla

xis

Infa

nt A

RV pro

phyla

xisExp

osed-in

fant

test

ed (b

y 18 m

onths)

Nu

mb

er


Source: UNICEF and WHO on behalf of the expanded Interagency Task Team on PMTCT, "A report card on the prevention of mother-to-child transmission of HIV and paediatric HIV care", 2006 (forthcoming).

Percentage of pregnant women who received an HIV test in the ten countries with the highest estimated number of HIV-infected pregnant women, 2005

Percentage of pregnant women who received an HIV test in the ten countries with the highest estimated number of HIV-infected pregnant women, 2005

0% 10% 20% 30% 40% 50%

South Africa

Kenya

Zimbabw e

Uganda

Tanzania

Zambia

Mozambique

D R of Congo

India

Nigeria

Percentage of pregnantwomen who received anHIV test


Trends in the cost of first-line antiretroviral therapy regimens in low-income and middle-income countries, 2004‒2006

Trends in the cost of first-line antiretroviral therapy regimens in low-income and middle-income countries, 2004‒2006

Middle-income countries

Low-income countries

151 151 123

450 435365

235308 325

576 554493

0100200300400500600700800900

J an - Dec. 2004 J an - Dec. 2005 J an - Dec. 2006Av

era

ge

tre

atm

en

t c

os

t p

er

pa

tie

nt

pe

r y

ea

r in

US

$

stavudine + lamivudine + nevirapine stavudine + lamivudine / efavirenz

zidovudine + lamivudine + nevirapine zidovudine + lamivudine / efavirenz

167

309

145

501 527

399

303346

269

642

772

623

0

100

200

300

400

500

600

700

800

900

J an - Dec. 2004 J an - Dec. 2005 J an - Dec. 2006Avera

ge t

reatm

ent

cost

per

pati

ent

per

year

in U

S$

stavudine + lamivudine + nevirapine stavudine + lamivudine / efavirenz

zidovudine + lamivudine + nevirapine zidovudine + lamivudine / efavirenz


Proportion of the estimated total number of HIV-positive tuberculosis cases identified through testing for HIV in 2005

Proportion of the estimated total number of HIV-positive tuberculosis cases identified through testing for HIV in 2005

0

100 000

200 000

300 000

400 000

500 000

600 000

700 000

Sub-Saharan Africa North Africa &Middle East

America &Caribbean

Europe & CentralAsia

East, South & SouthEast Asia

Global

Est

imat

ed n

um

ber

of

HIV

po

siti

ve T

B c

ases

Proportion of HIV-positive tuberculosis cases identified through testing Estimated number of HIV-positive tuberculosis cases

13%0.4% 66% 8%

8%

14%


Time trends in prevalences of gonorrhoea, chlamydia, syphilis among female sex workers in Cotonou, Benin, 1993-2005

Time trends in prevalences of gonorrhoea, chlamydia, syphilis among female sex workers in Cotonou, Benin, 1993-2005

Source: Labbé AC, et al.

0

5

10

15

20

25

30

35

40

45

50

1993 1994 1995 1996 1997 1998 1998 1999 2000 2001 2002 2003 2004 2005

Pe

rce

nta

ge

Gonorrhoea

Chlamydia

Syphilis


Low-income and middle-income countries implementing WHO drug resistance surveys and the proposed WHO HIVDR Laboratory Network in 2006

Low-income and middle-income countries implementing WHO drug resistance surveys and the proposed WHO HIVDR Laboratory Network in 2006

towards universal access scaling up priority hiv/aids internventions in the health sector

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