Public health approach is key to scaling up HIV treatment, says WHO HIV/AIDS director
6 December 2005 - Abuja – Speaking today at the 14th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA), in Abuja, Nigeria, Jim Yong Kim, Director of the World Health Organization (WHO) HIV/AIDS Department, emphasized the importance of a public health approach in promoting long-term sustainability and equity of HIV treatment access programmes in resource-limited settings.
Among the elements of the public health approach cited by Kim as contributing to the success of treatment scale-up around the world are:
- use of simplified and standardized first- and second-line antiretroviral treatment regimens, including fixed-dose combinations;
- initiation of therapy and monitoring of patients using simple clinical criteria and laboratory tests;
- making optimal use of limited human resources by shifting routine patient monitoring and follow-up tasks from physicians to nurses and community workers; and
- extensive involvement of affected communities and people living with HIV/AIDS in programme design and delivery, especially in the areas of community education and patient support.
"The public health approach represents a tremendous advance in how we implement treatment scale up, expand access and promote health equity,” said Dr. Kim. “It is because of this type of approach that more than 50 countries have doubled the number of people on treatment between June 2004 and December 2005. In Africa, simplified approaches are particularly important because they provide us with ways to scale up treatment without the need for expensive infrastructure to be in place.”
In December 2003, WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) declared the lack of access to HIV treatment to be a public health emergency and launched a strategy to support the scale-up of access to antiretroviral treatment to three million people living with HIV/AIDS in low- and middle-income countries by the end of 2005 (the "3 by 5" target). ”3 by 5” has helped to mobilize international action on expanding treatment as a first step towards the goal of universal access recently endorsed by G8 leaders and the 191 Member States of the United Nations at the UN World Summit in September.
Treatment is not an end itself, Kim noted. " We are finding that treatment is also key to improving HIV prevention", he said. "Countries such as Botswana, Swaziland and Uganda are showing that improved access to treatment increases demand for HIV counselling and testing as well as other prevention services. While treatment makes prevention more effective, it is also essential that we do prevention better so that treatment programmes can be sustained over the long term".
Kim highlighted Lesotho as one country that is aiming to scale up treatment and prevention at the same time, notably with its recent commitment to offering everyone in the country an HIV test. "Testing is a very important gateway to both treatment and prevention, and yet tragically few people are aware of their HIV status", Kim said. "Lesotho is showing that countries may need to take bold steps to ensure that their citizens get the health care they need".
WHO is promoting public health approaches through initiatives such as the Integrated Management of Adolescent and Adult Illnesses (IMAI) and Integrated Management of Childhood Illness (IMCI) programmes, which will be implemented in up to 30 countries by the end of this year. These programmes have been developed over several years and include a comprehensive training programme for health and community workers to deliver HIV/AIDS treatment and prevention services in low- and middle-income countries.
“Simplified treatment regimens, standardized clinical management, improved patient care systems and population-based drug-resistance monitoring are helping health systems across Africa to do what no one thought was possible,” Dr Kim noted, "and that is deliver chronic care".
As a result of technical support through initiatives such as "3 by 5" and resources made available to countries by the Global Fund to Fight AIDS, TB and Malaria and the US President's Emergency Plan for AIDS Relief, the number of people on HIV treatment globally has increased from 400 000 to over one million in the last two years. The pace of treatment scale-up has been most encouraging in sub-Saharan Africa – the region most heavily affected by HIV/AIDS - where approximately 500 000 people were receiving treatment by June 2005, triple the number of people on treatment twelve months previously.
In his remarks today, Kim emphasized that achieving universal access will involve tackling significant challenges. These include the need to ensure financial sustainability of HIV/AIDS programmes and better-coordination of technical support at country level. Drug supply systems still need to be strengthened in many countries and affordable second-line regimens and appropriate regimens for children are badly needed. But, he said, sufficient experience had now been built in many countries for him to be confident that these obstacles could be overcome. "Treating everyone in need is a huge challenge", said Kim. "Although each country will need to decide its own path, we have more and more evidence that a public health approach works".
For further information, please contact:
Anne Winter, Abuja, tel: +41 79 440 6011,
Klomjit Chandrapanya, Geneva, tel: +41 22 791 5589, email: firstname.lastname@example.org,
WHO North American HIV/AIDS Media Line, (+1 212) 584 5031