Strategy Finance Integration Cascade of services People centred Political Will Treat All : From Policy to Action - What will it take? Thursday, 9 June, 13.00 14.30 Conference Room 11, United Nations
Questions for discussion 1.90 90 90 What s the progress? 2.From recommendations to policy uptake: where are we? 3.From policy to implementation: what will it take? 2
Progress in access to antiretroviral therapy: 2000 2016 3
Progress in Paediatric Infection and Access to Treatment, 2010 2016 4
High impact of ART in survival and HIV transmission Source: Adapted from Lohse et al, 2007; Hoog et al, 2008, May et al, 2011; Hogg et al, 2013 5
Global targets for HIV programmes 90-90-90 global targets 100% 90% 81% 80% 60% 40% 20% 0% 36.9 million 73% 33.2 million 29.5 million 26.9 million 100% 80% 60% 40% 20% 0% 36.9 million 53% 41% 32%* 13.4 mil Not diagnosed The reality 14.9 mil Not treated 19.8 million 15.0 million 15.3 mil Not virally supressed 11.6* million Ref: UNAIDS. 90-90-90 An ambitious treatment target to help end the AIDS epidemic. 2014; JC2684 (Numbers as of March 2015) How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 LESSONS OF HOPE FROM THE AIDS RESPONSE July 2015. 6 UNAIDS 2014-2015
WHO ARV Consolidated Guidelines 2016 Reach the Treatment targets by 2020
What s new in the ARV Guidelines? Treat all PLHIV of all ages and populations eligible to start at any CD4 cell count Using ARVs for Prevention Pre exposure prophylaxis (PrEP) to prevent HIV among people at significant risk of HIV Optimized ARV regimens new ARV drug classes and better formulations Improved service delivery approaches to reach all people at all ages Health systems strengthening to avoid ARV stocks out and risk the development of HIV drug resistance 8
Improved service delivery through differentiated models of care New recommendations for: Linkage to care with Rapid initiation of ART Adherence Retention people-centered integration with other services including STIs and NCDs New policies to improve programme efficiency: Less frequent clinic visits Less frequent medication pick-up visits for stable patients Trained lay providers can distribute ART in the community 9
Movement to Treat All happening Policy uptake for adults and adolescents, June 2016
Policy uptake to full implementation, June 2016
The success story of treat all for pregnant women, June 2016
From policy to implementation: what will it take? Rapid policy adoption Costed scale up plans and upfront investments Identify efficiency gains through better testing, differentiated care & affordable drugs Use data to address gaps in the prevention and treatment cascade Strong focus on key populations and locations 13
Panel Open Discussion
Panel Questions 1. South Africa has taken the bold decision to finance test and treat and has almost 3.4 million people on treatment more than any other country on the world. How will you sustain progress? 2. Thailand has eliminated mother to child transmission of HIV and syphilis a tremendous achievement what lessons from that initiative can Thailand bring to securing treatment cover for all in need? 3. West Africa faces some of the world s most significant challenges in strengthening health systems. What lessons and insights can Cote D Ivoire share on building sustainable health systems that work for people living with HIV? 15
Panel Questions 4. The United States has been a remarkable partner in the global AIDS response we are now starting to engage in a new era for development. What does the future look like for development partnerships? How can they be optimized around a Treat All focus? 5. China is currently developing a national HIV strategy given the size of China and the highly concentrated nature of the epidemic how will Treat All be secured for populations that are hard to reach? 6. Civil society voices are critical in driving global and local progress towards expanded treatment access and quality. What messages will civil society bring to ensure implementation of our collective Treat All agenda? 16
Panel Open Discussion
Evolution of global ART coverage and eligibility criteria according WHO guidelines (2003 2016) 40,000,000 35,000,000 30,000,000 PLHIV 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 0 CD4 < 200 CD4 < 200 1 1% 5% CD4 < 350 2 CD4 < 500 3 2003 2006 2010 2013 2015 1. At CD4 < 350: active TB disease and HIV+ pregnant women 2. At any CD4: active TB disease and HBV co infection requiring HBV treatment 3. At any CD4: active TB disease, HBV co infection with severe liver disease, HIV+ pregnant women and HIV serodiscordant couples 21% 36% at any CD4 43% not elegible elegible but not on ART on ART Source WHO Progress Report :Global Health Sector Response to HIV, 2000 2015 ( 2015)