Transcript Towards Universal Access Scaling up priority HIV/AIDS internventions in the health sector Progress Report, April 2007 1| Progress Report | April 2007

Towards Universal Access
Scaling up priority HIV/AIDS internventions in
the health sector
Progress Report, April 2007
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Progress Report | April 2007
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Progress Report | April 2007
Estimated number of people receiving and needing antiretroviral therapy, and percentage coverage in low- and middle income
countries according to region, December 2006
Geographical Region
Estimated
need
Coverage
1 340 000
4 800 000
28%
Latin America and the Caribbean
355 000
490 000
72%
East, South and South-East Asia
280 000
1 500 000
19%
35 000
230 000
15%
5 000
77 000
6%
2 015 000
7 100 000
28%
[1.8 – 2.2 million]
[6.0 – 8.4 million]
[24 – 34%]
Sub-Saharan Africa
Europe and Central Asia
North Africa and the Middle East
Total
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Progress Report | April 2007
Number of people
receiving ARV
therapy
Estimated number of children aged under 15 years receiving and needing antiretroviral therapy, and percentage coverage in
low- and middle income countries according to region, December 2006
Geographical region
Estimated
number of
children
receiving
antiretroviral
therapy
Estimated need among
children
Estimate
Coverage
Low
estimate
High
estimate
Estimate
Low
estimate
High
estimate
Sub-Saharan Africa
85 000
680 000
510 000
890 000
13%
10%
17%
Latin America and the
Caribbean
15 500
23 000
16 000
37 000
67%
42%
97%
East, South and
South-East Asia
13 300
64 000
32 000
120 000
21%
11%
42%
Europe and Central
Asia
1 500
7 500
3 800
14 000
20%
11%
39%
North Africa and the
Middle East
<100
10 000
4 400
20 000
<1%
0%
1%
115 500
780 000
600 000
1 000 000
15%
12%
19%
TOTAL
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Progress Report | April 2007
Number of people receiving ARV therapy in low- and middle-income countries, 2002—2006
1 800
North Africa and the Middle East
Europe and Central Asia
1 600
East, South and South-East Asia
Latin America and the Caribbean
1 400
Sub-Saharan Africa
1 200
1 000
800
600
400
200
Progress Report | April 2007
6
en d
- 200
006
mi d
-2
200
5
en d
005
mi d
-2
200
4
en d
004
mi d
-2
200
3
en d
mi d
-2
en d
5|
003
0
200
2
People receiving ARV therapy (in thousands)
2 000
Unmet need in low- and middle-income countries according to region, December 2006
5 000 000
4 500 000
68% of the total unmet need
4 000 000
Unmet need ARV
therapy
Receiving ARV
treatment in Dec 2006
Number of people
3 500 000
3 000 000
2 500 000
2 000 000
1 500 000
1 000 000
500 000
0
Sub-Saharan
Africa
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Progress Report | April 2007
Latin America
and the
Caribbean
East, South and
South-East Asia
Europe and
Central Asia
North Africa and
the Middle East
Estimated antiretroviral therapy coverage of at least 28% in low- and middle-income
countries, December 2006a
75%
a28%
is the overall ART coverage for low-income and middle-income countries. Only countries with an estimated ART
need of at least 1000 are included in this graph.
The bar indicates the uncertainty range around the estimate.
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Progress Report | April 2007
Eth iopia
Côte d
'Ivoire
Algeria
Les oth
o
Ec uado
r
Sou th
Afric a
Zambia
Sen eg
al
Mali
G abon
Domin
ic an Re
pub lic
Haiti
Ben in
Hondu
ras
Burk ina
Fas o
El Salv
ado r
Swaz il
and
Ugand
a
Moroc c
o
Ken ya
Malaw
i
Peru
obago
Tri nid a
d and T
J amaic
a
G uatem
ala
Urugua
y
Colom
bia
Pan am
a
Paragu
ay
Mex ic o
Rwand
a
G uyan
a
Namib
ia
Ven ezu
ela
Chile
Argenti
na
Botswa
na
Cos ta
Ric a
25%
Braz il
50%
Cuba
Cambo
dia
Thail an
d
ART coverage
100%
Fifteen low- income and middle- income countries with the highest estimated numbers of people receiving
treatment, and corresponding estimated antiretroviral therapy coverages, December 2006
400 000
100%
350 000
90%
80%
300 000
70%
250 000
60%
200 000
50%
150 000
40%
30%
100 000
20%
50 000
10%
In
di
Bo
a
ts
a
w
an
a
Za
m
bi
a
M
al
aw
i
N
ig
er
ia
U
ni
Et
te
h
d
io
R
pi
Zi
ep
a
m
ub
ba
a
l ic
bw
of
e
Ta
nz
M
an
oz
am ia
bi
qu
e
M
ex
ic
o
Af
ric
So
ut
h
Br
az
il
Ke
ny
a
Th
ai
la
nd
U
ga
nd
a
0%
a
0
The estimated ART coverage is currently under review and will be adjusted, as appropriate, based on new data
collected during 2006. Preliminary analysis suggests that numbers lie within these ranges.
a
The bar indicates the uncertainty range around the estimate.
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Progress Report | April 2007
Number of people on treatment
Percentage ART coverage
Low-income and middle-income countries with antiretroviral therapy coverages of at
least 25% among children under 15, 2006a
B razil
>95%
Thailand
>95%
B o tswana
95%
94%
Cambo dia
86%
A rgentina
71%
Namibia
51%
Guatemala
35%
Rwanda
34%
Ho nduras
0%
aOnly
20%
60%
countries with an ART need among children of at least 1000 are included in this graph.
The bar indicates the uncertainty range around the estimate.
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40%
Progress Report | April 2007
80%
100%
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Progress Report | April 2007
Treatment access among injecting drug users (IDUs) in Eastern Europe, selected
countries, 2004
100
90
80
Percentage
70
IDUs as % of people on
ART
60
IDUs as % of reported HIV
cases
50
40
30
20
10
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Progress Report | April 2007
kr
ai
ne
U
Fe
de
r
at
io
n
a
us
si
an
of
M
ol
do
v
R
R
ep
ub
lic
Li
th
ua
ni
a
vi
a
La
t
Es
to
ni
a
0
Percentages of men reporting symptoms of STIs in the last 12 months who sought care at
a service provider with personnel trained in STI care, 2002-2005
20
am
03
er
oo
n
20
04
G
ha
na
20
03
Ke
ny
M
a
oz
20
am
03
bi
qu
e
20
03
N
ig
er
ia
U
20
ga
03
nd
a
20
04
-0
Za
5
m
bi
a
20
Vi
03
et
N
am
20
D
05
om
Bo
l iv
in
ic
ia
an
20
R
03
ep
ub
lic
20
02
C
Bu
rk
in
a
Fa
so
Percentage
80
70
60
50
40
30
20
10
0
Country and year of survey
Source: Demographic and Health Surveys (DHS), MEASURE DHS
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Progress Report | April 2007
Probability of death in African children starting antiretroviral therapy (ART) according to age at ART initiation (n = 1195). KIDSART-LINC Collaboration, February 2007
0.20
0.15
<12 months
Probability
12-35 months
36-59 months
≥5 years
0.10
0.05
0.00
0.0
0.2
0.6
0.4
Time (years)
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Progress Report | April 2007
0.8
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Progress Report | April 2007
Source: National AIDS Control
Organization (NACO), Ministry of
Health, India
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Progress Report | April 2007
Probability of death among people on antiretroviral therapy in four ART programmes in Côte
d'Ivoire, Malawi and South Africa, February 2007
Cumulative mortality (%)
15%
10%
5%
0%
0
6
12
18
24
Months since starting antiretroviral therapy
Kaplan-Meier curves of probability of death in 7109 HIV-1-infected patients treated in four large ART programmes in Côte d'Ivoire, Malawi
and South Africa. Results from individual clinics are shown in grey, combined estimates in blue. ART-LINC (ANRS/NIH) Collaboration,
February 2007.
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Progress Report | April 2007
Institutional deaths per 100 000 population and programmatic data: patients currently receiving antiretroviral therapy and
deaths on therapy, Botswana 1994-2005a
Patients receiving antiretroviral therapy
Deaths of those on therapy
45 120
45 000
Deaths per 100 000 population
600
Deaths per 100 000 population
50 000
40 000
2002 estimated from
mortality reports
500
35 000
30 600
30 000
400
25 000
300
20 000
200
15 000
10 858
10 000
100
3 515
5 000
0
0
1994
a2005
1996
1997
1999
2000
2001
2002
2003
2004
2005
deaths annualized on basis of deaths until June 2005, reported by November 2005; ART programme data reported until
September 2005.
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Progress Report | April 2007
People currently receiving antiretroviral therapy
700
Ten low-income and middle-income countries with the highest estimated numbers of HIV-infected pregnant women and corresponding
percentages of HIV-infected pregnant women who received ARVs for PMTCT, 2005
450 000
35%
Estimated number of HIV-infected pregnant women
400 000
% of pregnant women who received ARVs for PMTCT
30%
350 000
25%
250 000
20%
200 000
15%
150 000
10%
100 000
5%
50 000
0
ica
Af r
h
ut
So
0%
Un
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Progress Report | April 2007
ia
I nd
a
ue
eri
biq
N ig
m
za
Mo
blic
pu
e
dR
of
T
ia
zan
n
a
ite
c
mo
De
da
go
an
on
C
Ug
e
f th
o
c
li
ub
ep
R
ic
rat
a
ny
Ke
bw
ba
m
i
Z
e
ia
mb
Za
Coverage
Number
300 000
Percentages of pregnant women who received an HIV test and percentages of HIV-infected pregnant women receiving ARVs
for PMTCT, selected countries, 2005a
Percentage of pregnant women who
received an HIV testb
Percentage of HIV-infected pregnant women
who received ARVs for PMTCTc
Botsw ana Botswana
Brazil
Thailand
Brazil
Thailand
Russian
Federation
Russian
Federation
100%
80%
60%
40%
20%
Ukraine
Ukraine
Argentina
Argentina
Jamaica
Jamaica
0%
0%
20%
40%
60%
80%
100%
aCountries
with at least 40% of HIV-infected pregnant women who received ARVs for PMTCT are included in this graph (countries with less than
500 estimated HIV-infected pregnant women are not included). Countries are ranked by the numbers of HIV-infected pregnant women, i.e.
Botswana has the highest number and Jamaica the lowest.
b Denominator
is estimated number of pregnant women (15-49 years old) as of 2005.
c Denominator
is estimated number of HIV-infected pregnant women (15-49 years old) as of 2005.
The bar indicates the uncertainty range around the estimate.
Source: UNICEF and WHO on behalf of the expanded Interagency Task Team on PMTCT, "A report card on the prevention of mother-to-child transmission of HIV and paediatric
HIV care", 2006 (forthcoming).
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Progress Report | April 2007
Number of PMTCT sites in Rwanda, 1999-2006
250
Number of sites
199
208
221
200
150
120
100
53
33
50
1
2
1999
2000
0
2001
2002
2003
Year
Source: Ministry of Health, Rwanda
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Progress Report | April 2007
2004
2005
mid-06
Selected PMTCT programme indicators, Rwanda, 2005
10 000
9 000
8 000
Number
7 000
6 000
5 000
4 000
3 000
2 000
1 000
Source: Ministry of Health, Rwanda
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Progress Report | April 2007
on
th
s)
xis
18
m
pr
op
hy
la
ed
(b
y
RV
In
fa
nt
A
at
er
na
lA
M
Ex
po
se
din
fa
nt
te
st
Pr
eg
na
nt
wo
m
en
id
en
tif
i
ed
RV
HI
V
-p
os
i
pr
op
hy
la
tiv
xis
e
0
Percentage of pregnant women who received an HIV test in the ten countries with the highest
estimated number of HIV-infected pregnant women, 2005
Nigeria
India
D R of Congo
Mozambique
Percentage of pregnant
women who received an
HIV test
Zambia
Tanzania
Uganda
Zimbabw e
Kenya
South Africa
0%
10%
20%
30%
40%
50%
Source: UNICEF and WHO on behalf of the expanded Interagency Task Team on PMTCT, "A report card on the prevention of mother-to-child transmission of HIV and paediatric
HIV care", 2006 (forthcoming).
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Progress Report | April 2007
Trends in the cost of first-line antiretroviral therapy regimens in low-income and middle-income
countries, 2004‒2006
Low-income countries
stavudine + lamivudine / efavirenz
zidovudine + lamivudine + nevirapine
zidovudine + lamivudine / efavirenz
Average treatment cost per
patient per year in US$
stavudine + lamivudine + nevirapine
900
800
700
600
500
400
300
200
100
0
576
554
450
365
308
235
151
493
435
151
Jan -Dec. 2004
325
123
Jan -Dec. 2005
Jan -Dec. 2006
Average treatment cost per
patient per year in US$
Middle-income countries
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Progress Report | April 2007
stavudine + lamivudine + nevirapine
stavudine + lamivudine / efavirenz
zidovudine + lamivudine + nevirapine
zidovudine + lamivudine / efavirenz
900
800
700
600
500
400
300
200
100
0
772
642
623
527
501
303
309
167
Jan -Dec. 2004
399
346
269
145
Jan -Dec. 2005
Jan -Dec. 2006
Proportion of the estimated total number of HIV-positive tuberculosis cases identified through testing
for HIV in 2005
Estimated number of HIV positive TB cases
700 000
600 000
500 000
400 000
300 000
200 000
8%
100 000
0.4%
66%
13%
8%
14%
0
Sub-Saharan Africa
North Africa &
Middle East
America &
Caribbean
Proportion of HIV-positive tuberculosis cases identified through testing
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Progress Report | April 2007
Europe & Central
Asia
East, South & South
East Asia
Global
Estimated number of HIV-positive tuberculosis cases
Percentage
Time trends in prevalences of gonorrhoea, chlamydia, syphilis among female sex workers in
Cotonou, Benin, 1993-2005
50
45
40
35
30
25
20
15
10
5
0
Gonorrhoea
Chlamydia
Syphilis
1993 1994 1995 1996 1997 1998 1998 1999 2000 2001 2002 2003 2004 2005
Source: Labbé AC, et al.
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Progress Report | April 2007
Low-income and middle-income countries implementing WHO drug resistance surveys and the
proposed WHO HIVDR Laboratory Network in 2006
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Progress Report | April 2007