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7/29/2019 1 ARV - HIV AIDS situation (CD).ppt
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The HIV/AIDS epidemicand access to antiretroviral treatmentin the Eastern Mediterranean Region of WHO
Regional meeting on
ARV pricing, procurement and supply management
5-7 April, 2005
WHO Regional Office for the Eastern Mediterranean
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Outline
HIV/AIDS epidemic situation
Country responses
ARV therapy 3 by 5 Initiative
ART situation in the EMR
WHO Regional Office for the Eastern Mediterranean
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The HIV/AIDS epidemic
situation in the EMR
WHO Regional Office for the Eastern Mediterranean
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Estimated number of adults and children
newly infected with HIV during 2004
Total: 4.9 (4.3 6.4)
million
Western & CentralEurope
21 000[14 000 38 000]
North Africa & Middle East
92 000[34 000 350 000]
Sub-Saharan Africa
3.1 million[2.7 3.8 million]
Eastern Europe& Central Asia
210 000[110 000 480 000]
East Asia
290 000
[84 000
830 000]South& South-East Asia
890 000[480 000 2.0 million]
Oceania
5 000[2 100 13 000]
North America
44 000[16 000 120 000]
Caribbean53 000[27 000 140 000]
Latin America
240 000[170 000 430 000]
Estimated number of deaths due to AIDS in the EMR: 28,000 (12T 72T)
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The HIV epidemic in the EMR
Concentrated
Low level Djibouti
Generalized
512 000
8 985
43 000
11 2271 447
3 584
7 000
941
14 00070 000
23330 000
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National responses to HIV/AIDS
Prevention targeting:
Young people
Risk behaviors & vulnerable groups
General population Blood safety, infection control
Control of Sexually Transmitted Infections
Voluntary counseling and testing
Prevention of mother-to-child transmission
Access to treatment, care and psychosocial
support for people living with HIV/AIDS
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ARV therapy
WHO Regional Office for the Eastern Mediterranean
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ARV therapy
ARVs attack the virus at a different stage of its replication,
preventing it from replicating further or, at a minimum,
slowing down replication.
Highly active antiretroviral therapy" (HAART) =
combination of at least three drugs from various classes of
ARVs into a "cocktail"
Common ARV classes:
NRTI, e.g. zidovudine (AZT, lamivudine (3TC) and abacavir
NNRTI, e.g. nevirapine and efavirenz
Protease inhibitors (PI), e.g. indinavir, ritonavir and lopinavir
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Challenges of ART
For PLWHA (people living with HIV/AIDS) lifelong commitment to medication (and all mental, physical,
social and economical consequences).
Some issues: cost, side effects, drug resistance, druginteractions, lifelong adherence
For health programmes / systems
High cost rational ART guidelines & price reductionstrategies
Capacity building needs: Human resources and health systeminfra-structure
Challenging logistics: interruption of treatment must be avoided!
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Can ARV treatment work
in resource-poor settings ?
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Example Uganda:
Effect of ARV therapy on survival
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ExampleSouth Africa:Effect of ART on markers of immune-competency
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The 3 by 5 Initiative
Focus on 5 critical areasamong them:
simplified, standardized tools for delivering ART
effective, reliable supply of medicines and diagnostics
Aim:
Access to ART for 3 million people in
developing/transitional countries by end of 2005
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Access to ART in countries
of the EMR
WHO Regional Office for the Eastern Mediterranean
Results of a questionnaire survey in February 2005
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ART Coverage(% of PLWHA in need)
>=10-50 %
>=50-80 %
< 10% (triple ART coverage)
Palestine
Bahrain
Kuwait
Djibouti
Lebanon
UAE
>80 %
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Antiretroviral therapy
number of eligibleHIV patients receiving ART
National target of HIV patients needing
ART by the end of 2005
Estimated number of HIV patients needs ART
Palestine
Bahrain
3200
Kuwait
Djibouti
500
62
Jordan37 75
280
54
7000
Unknown
(50,000-
80,000?)
224
Lebanon200
200
UAEna
20
50 (10 triple
3202
3775
160
196
140
400
5411224
0
500
62
40 75
200
300
200
100 (?)
20,000
250 54
missing
missing
missing
1,370missing600