1 ARV - HIV AIDS situation (CD).ppt

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



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The HIV/AIDS epidemic

situation in the EMR



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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



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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


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

1 ARV - HIV AIDS situation (CD).ppt

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