FAST-TRACK: HIV Prevention, treatment and care to End the AIDS epidemic in Lesotho by 2030

Transcription

1 Evidence informed, responsive and sustainable care FAST-TRACK: HIV Prevention, treatment and care to End the AIDS epidemic in Lesotho by 2030 Alti Zwandor UNAIDS Country Director Maseru, Lesotho 9 December 2014

2 Source: UNAIDS

3 People receiving antiretroviral therapy, 2005 to June 2014, all countries

4 Antiretroviral therapy coverage for adults and children, 2013

5 Numbers of children receiving antiretroviral therapy,

6 Building on past achievements: funds invested in AIDS programmes in low- and middle-income countries, PEPFAR: The United States President s Emergency Plan for AIDS Relief Sources: UNAIDS estimates, UNAIDS Kaiser Family Foundation reports on financing the response to HIV in low- and middle-income countries, GARPR 2014, philanthropic resource tracking reports from Funders Concerned About AIDS, reports from the Global Fund and UNITAID.

7 What has been achieved in Lesotho as of 2013? 29% of adults living with HIV were receiving ART by end % of all children living with HIV were on ART in 2013 New infections have declined by 13% since 2005 compared to -32% in SA and -65% Malawi Adult new HIV infections declined by 18% from 2005 and 2013 Children newly infected is 41% lower than % ART coverage of pregnant women living with HIV AIDS related death declined by 27% since 2005 (-48% in SA, - 51% in Malawi) male medical circumcisions done between (more than six fold increase)

8 Percent of women receiving antiretroviral drugs to prevent MTCT In 10 countries, >=30% of pregnant WLHIV did not receive ARV drugs 99% 96% 100% 90% 90% 84% 90% 2015 target: 90% coverage 79% 78% 76% 75% 75% 80% 73% 70% 63% 62% 61% 58% 53% 55% 60% 50% 39% 33% 27% 40% 30% 19% 20% 10% 0% Chad Nigeria DR Congo Angola Lesotho Ethiopia Burundi Cameroon Ghana Kenya Tanzania Côte d'ivoire Uganda Zambia Zimbabwe Malawi Mozambique South Africa Namibia Botswana Swaziland Source: UNAIDS 2013 estimates

9 Stalling or regressing: 9 countries stalled or declined in PMTCT coverage between 2012 and 2013* *Among countries with less than a 10% point improvement Excludes saturation countries Botswana and South Africa (>=90%)

10 Average reduction, 43%

11 Estimated New HIV Infections All Age Estimated New HIV Infections - All Ages Number of new HIV infections Botswana Lesotho Swaziland

12 Estimated New HIV Infections Children < 15 Years Estimated New HIV Infections - < 15 Years Number of new HIV infections <500 Botswana Lesotho Swaziland

13 Estimated Adult and Children ART Coverage, 2013 Estimated Adult and Children ART Coverage, 2013 % of adults & children on ART Botswana Lesotho Swaziland Estimated Adult ART coverage % Estimated Paediatric ART coverage %

14 Estimated AIDS related deaths Estimated AIDS related deaths Number of AIDS-related Deaths Botswana Lesotho Swaziland

15 Percent HIV Women Receiving ART to PMTCT Percent HIV Women Receiving ART to PMTCT 92 >95 >95 No. of HIV+ women delivering Botswana Lesotho Swaziland

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17 Lesotho Key Issues 1. Two out of three PLHIV NOT accessing ART 2. Only 3 out of 20 children living with HIV are on ART 3. New HIV infections increased from (2012) to 26,000 (2013) 4. AIDS related deaths increased from (2011) to (2013) the period when most countries experienced highest annual decline 5. Adolescents form the least aware of their HIV status 6. Only 8218/ (53%) women needing PMTCT services accessed services in Five districts account for 75% of the national burden of HIV % of new HIV infections in 2013 occurred in Maseru district

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19 Targets for ending the AIDS epidemic

20 What will it take to End the AIDS epidemic in Lesotho by 2030? We can End the AIDS Epidemic by 2030 Global consensus that the tools now exist to end the AIDS epidemic Major scientific breakthroughs and lessons learned over more than a decade of scaling up the AIDS response worldwide HIV treatment WORKS! - extend the lifespan of people living with HIV and effectively prevent HIV transmission Combination HIV prevention beyond medicines sharply lower rates of new HIV infections Combination includes ART, condom programming, behaviour change, voluntary medical male circumcision and programmes with key populations HIV programmes are dramatically strengthened when they are combined with social and structural approaches

21 Building on past achievements 13.6 million people on ART as of June the world is on track for 15 X 15 progress for children is lagging behind- At end 2013 adults ART coverage was 38% but only 24% for children; increase in the number of children on ART during the first half of 2014 was only 3% compared to a 6% increase for adults Total of 6 million men circumcised in sub-saharan Africa since 2007 of which 1 million men were newly circumcised in 2013 Positive trends in behaviour change - household surveys in sub-saharan Africa in show an increase in young people s HIV-related knowledge and more condom use among adults, compared to surveys in

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23 New HIV infections in low- and middle-income countries, , with achievement of ambitious Fast-Track Targets, compared to maintaining 2013 coverage

24 AMBITIOUS TARGETS ARE ENTIRELY ACHIEVABLE Time-bound targets and frameworks drive progress, promote accountability and unite diverse stakeholders in pushing towards common goals new Fast-Track Targets have been established for the post-2015 era to transform the vision of three zeros into concrete milestones and end-points Fast-Track Targets for prevention programmes are even higher than recommended in investment approach Increase coverage of outreach HIV prevention programmes for key populations Expand access to biomedical prevention tools 80% VMMC target by 2020,

25 RAPID PROGRESS IS CRUCIAL Rapid progress must be made by 2020 to end the AIDS epidemic by 2030 Next six years is pivotal to global prospects for bringing the AIDS epidemic to an end An accelerated pace for HIV prevention and treatment approaches will limit the epidemic and enable progress towards the elimination phase Quickening the pace to achieve the Fast-Track Targets would reverse the AIDS epidemic by 2020

26 REACHING THE FAST-TRACK TARGETS WILL EFFECTIVELY END THE AIDS EPIDEMIC Fast-Track benefits include: Avert 13 million new HIV infections through heterosexual transmission Rapid progress towards the goal of eliminating new HIV infections among children will avert 5.6 million new infections in children

27 SERVICE DELIVERY WILL NEED TO IMPROVE Strategically focused testing initiatives to effectively reach those at greatest risk Use multiple testing strategies to reach -90% of all people living with HIV know their HIV status Sustainable approaches - focus on community service delivery to cover 30% of total service delivery - 95% of HIV service delivery is currently facility based Build the capacity of health and community systems If ambitious targets are met by 2020, the number of PLHIV 2030 would decline to 29.3 million The cost of inaction will be huge Maintaining current treatment and prevention services will see PLHIV increase to 41.5 million in 2030

28 Ending the AIDS epidemic eight action points 1. Protect human rights, embrace the human family and leave no one behind 2. Invest in communities 3. Think big secure leadership and investments 4. Focus on local epidemics and populations 5. Decentralize delivery of HIV services 6. Expand the choices for HIV prevention and treatment 7. Integrate HIV programmes with other health and development programmes 8. Innovate and invest in science for a cure and

29 The Road toward : Key challenges to overcome 1. Stigma & discrimination deters service scale-up 2. Treatment challenges facility level costs, pooled procurement & technical support, quality vs uptake/retention, routine viral load monitoring 3. Treatment delivery methods simplified regimens and scale up of point-of-care diagnostic tools 4. Civil society strengthening skills & capacities integral part of the HIV response 5. Resources (financial, human, equipment, materials) required to finance and sustain the push to achieve targets 6. Maximizing the efficiency and impact of national responses

30 Fast Track Benefits in Lesotho By 2015 By 2020 By 2030 HIV Population 329,000 Adult Prevalence 22.4% New HIV Infections 18,700 AIDS Related Deaths 18,000 AIDS Orphans 165,000 MTCT with Breastfeeding 12.2% Life birth 52 years HIV Population 312,000 Adult Prevalence 19.3% New HIV Infections 5,600 AIDS Related Deaths 5,800 AIDS Orphans 138,000 MTCT with Breast feeding 6.0% Life birth 61 years HIV Population 289,000 Adult Prevalence 12.3% New HIV Infections 4,800 AIDS Related Deaths 3,600 AIDS Orphans 53,000 MTCT with Breastfeeding 6.0% Life birth 64 years

31 Thank you