Senegal Triples Number of People on HIV Treatment
Credits International Partnerships and Policy Reforms for Success
DAKAR, 28 MARCH 2006 – More than 4400 people, or almost half of all people in need, are now receiving lifesaving antiretroviral treatment (ART) in Senegal, nearly three times the number in June 2004, when only 1 600 people were on treatment.
Progress in treatment scale-up in Senegal has been achieved despite challenges posed by a centralized public health infrastructure and weak procurement and supply management systems. With the support of many partners, including people living with HIV, and inspired by WHO's flexible IMAI* capacity-building approach, Senegal has decentralized and expanded its HIV treatment programme, increasing the number of physicians qualified to dispense antiretroviral medicines from 12 in 2001 to 95 in 2005 and the number of antiretroviral treatment sites from six to 32 in the past two years. Prevention of mother-to-child transmission services, which in 2004 were available only in Dakar, the capital, are available in all 11 regions. And Senegal now has thirteen voluntary counselling and testing centres, as well as voluntary testing services available in all 56 health districts.
"HIV/AIDS is a significant obstacle to achieving Senegal’s national development goals,” noted Mr Abdou Fall, Senegal’s Minister of Health. “By working with our “3 by 5” partners and donors, we have developed strategies that maximize our human resource capabilities and made significant strides in delivering quality healthcare to our people.” Minister Fall was speaking at a briefing in Dakar to release the report, Progress on Global Access to HIV Antiretroviral Therapy: A Report on “3 by 5” and Beyond, which provides an overview of “3 by 5,” a two-year strategy, launched on 1 December 2003, World AIDS Day, by WHO and UNAIDS, to ensure treatment for 3 million people living with HIV in low-and middle-income countries by the end of 2005.
While Senegal has a relatively low HIV prevalence rate, estimated at slightly below 1% of the adult population, the government has acted aggressively to address the epidemic. Even at a relatively low infection rate, HIV represents a public health crisis, with an estimated 41 000 adults and 3 100 children living with HIV at the end of 2003, and approximately 3 500 premature deaths from AIDS in that year alone. Senegal is also home to more than 17 000 orphans due to AIDS.
To reduce the rate of premature deaths and sickness, Senegal actively participated in the “3 by 5” initiative to expand access to antiretroviral therapy. Because of limited health workers trained outside of the capital city, weak infrastructure capacity, the need to provide a continuum of treatment and care and the challenges posed by integrating HIV monitoring into the public health system, the government invested in a national programme to decentralize health services with assistance from WHO and other international partners.
Working with WHO and other partners, Senegalese officials rapidly scaled up access to HIV therapy in the country by:
- Developing a national policy for HIV treatment and care;
- Training regional health staff;
- Harmonizing first- and second-line ARV regimens;
- Procuring equipment, such as CD4 testing technology, for regional laboratories;
- Updating guidelines;
- Developing new policies, norms and tools for the prevention of mother-to-child transmission and for voluntary testing;
- Developing a mentoring approach by national “experts” for each region in the country to provide treatment advice to health workers and undertake supervisory missions;
- Establishing a Regional Coordination Team;
- Developing a simplified and standardized data questionnaire for patients; and
- Customizing WHO’s IMAI guidelines for use in Senegal.
The political and financial commitment displayed by Senegal’s government is now paying dividends. Between 2003 and 2004, Senegal increased its AIDS budget from US$12 million to US$19 million and the country was one of the first to offer free access to ART, thereby increasing equity of access for poor and marginalized populations. Testing services are also offered free of charge.
"In just two years, Senegal has demonstrated that, even when faced with weaknesses in the health sector that many believed insurmountable, flexible ideas and strong leadership can create an unstoppable treatment momentum and accomplish what was previously thought impossible," said WHO HIV/AIDS Department Associate Director, Dr Teguest Guerma.
With a view to moving towards universal access to prevention, treatment and care, Senegal is now committed to making ART available in all districts, and to expanding treatment and care of opportunistic diseases and support to people living with HIV/AIDS. Senegal’s ability to achieve universal access will, however, require further strengthening of the health sector and of drug procurement and supply management systems, as well as systems for monitoring adherence to treatment and drug resistance. And as with many developing countries, future progress will depend on a stable source of long-term international financing.
"Senegal has made significant progress,” said Dr Agathe Frappier, Head of Aid for the Canadian International Development Agency in Senegal. “Thousands of people in Senegal have already been touched by, and will continue to benefit, from this programme. Canada is pleased to see such a great example of the momentum that is bringing about such positive change for people living with HIV.”
By providing technical support and mobilizing joint action by UN and other partners, UNAIDS Secretariat and WHO have helped to secure an additional three years funding from the Global Fund for Senegal’s HIV programme. UNAIDS and WHO will continue to provide key strategic information and facilitate civil society’s engagement in planning, decision-making and implementation of HIV programmes in Senegal.
* IMAI is the Integrated Management of Adolescent and Adult Illness approach which promotes an integrated service delivery model for managing HIV. It includes a training package that provides all types of health workers with the skills and knowledge to deliver antiretroviral therapy and support the task-shifting that is needed not just to scale up antiretroviral therapy and prevention, but for all chronic disease treatment, prevention and care.
Khalifa Mbengue | WHO Dakar | tel. +221 869 5944 | mobile +221 545 83 81| firstname.lastname@example.org
Klomjit Chandrapanya | WHO Geneva | tel. +41 22 791 5589 | mobile +41 79 509 0622 | email@example.com
Anne Winter | WHO Geneva | tel. +41 79 440 6011 | firstname.lastname@example.org
Dominique de Santis | UNAIDS Geneva | tel. +41 22 791 4509 |email@example.com