Transcript Access to HIV/AIDS Medicines The 3x5 strategy WHO/EDM Technical Briefing Seminar World Health Organization "3 by 5" Target http://www.who.int/3by5

Access to HIV/AIDS Medicines
The 3x5 strategy
WHO/EDM Technical Briefing
Seminar
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
Content of the presentation
Challenges:
• how serious is the HIV/AIDS pandemic?
Opportunities:
• What is the global response to address the
challenges?
• What is 3by5?
• What are the roles of the AMDS and EDM in
3by5 ?
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
Challenges
Magnitude
• Numbers
• Treatment gap
• Cost
• Capacity required
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
Challenges
Millions
Global AIDS epidemic
1990−2003
Number
of people
living
with HIV
and AIDS
50
Number of people living with HIV and AIDS
5.0
% HIV prevalence, adult (15-49)
40
4.0
30
3.0
20
2.0
10
1.0
0
0.0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
World Health Organization
Source: UNAIDS/WHO, 2004
2004 Report on the Global AIDS Epidemic (Fig 1)
"3 by 5" Target
http://www.who.int/3by5
% HIV
prevalence
adult (15-49)
Challenges
About 14 000 new HIV infections a day in
2003

More than 95% are in low and middle income
countries

Almost 2000 are in children under 15 years of age

About 12 000 are in persons aged 15 to 49 years,
of whom:
— almost 50% are women
— about 50% are 15–24 year olds
00003-E-5 – July 2004
Challenges
Global summary of the HIV and AIDS epidemic,
December 2003
Number of people living with HIV in 2003
People newly infected with HIV in 2003
AIDS deaths in 2003
Total
37.8 million (34.6 – 42.3million)
Adults
35.7 million (32.7 – 39.8 million)
Children under 15 years
2.1 million (1.9 – 2.5 million)
Total
4.8 million (4.2 – 6.3 million)
Adults
4.1 million (3.6 – 5.6 million)
Children under 15 years
630 000 (570 000 – 740 000)
Total
2.9 million (2.6 – 3.3 million)
Adults
2.4 million (2.2 – 2.7 million)
Children under 15 years
490 000 (440 000 – 580 000)
The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available
information.
00003-E-6 – July 2004
Challenges
Yearly deaths as a factor of total in 1995
Widening Gap of AIDS Treatment
2.0
Source: Adapted from WHO/UNAIDS Statistics & HIV/AIDS Surveillance in Europe,
End-year report 2001, No 66, CESES
AIDS Deaths
in Africa
1.5
1.0
AIDS Deaths in
Western Europe
0.5
Introduction of Highly Active
Antiretroviral Treatment (HAART)
0.0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2003
Challenges
Antiretroviral therapy coverage for adults,
end 2003
400,000 people on treatment: 7% coverage
60
50
40
%
30
20
10
0
Africa
Source: UNAIDS/WHO, 2004
2004 Report on the Global AIDS Epidemic (Fig 33)
Asia
Latin
America and
the Caribbean
Eastern
Europe and
Central Asia
North
Africa and
Middle East
High burden countries in
need of ART, Nov 2003
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
Challenges
Projected annual HIV and AIDS financing needs
by region, 2004−2007 (in US$ million)
US$ millions
20,000
Latin America
and the Caribbean
Eastern Europe
and Central Asia
15,000
North Africa
and Middle East
10,000
East Asia
and the Pacific
South
and South-East Asia
5,000
Sub-Saharan Africa
0
2004
Source: UNAIDS, 2004
2004 Report on the Global AIDS Epidemic (Fig 35)
2005
2006
2007
Opportunities
Shifts
• Political will
• Prices
• Positive stories
• "Pecunia"
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
Opportunities
Prices (US$/year) of a first-line
antiretroviral regimen in Uganda: 1998−2003
14 000
10 000
8 000
6 000
4 000
2 000
0
Jun Jul Aug Sep
98 98 98 98
Jun Oct Nov Dec Jan Feb Mar Apr May Jun Jul
00 00 00 00 01 01 10 01 01 01 01
Price US$
Price US$
12 000
Aug
01
1 200
1 100
1 000
900
800
700
600
500
400
300
200
100
0
Nov
00
Source: UNAIDS/WHO, 2004
2004 Report on the Global AIDS Epidemic (Fig 34)
Mar Sep Oct
03 03 03
Dec
00
Jan
01
Feb
01
Mar
01
Apr
01
May
01
Jun
01
Jul
01
Oct
03
Opportunities
Khayelitsha: Availability of decentralized antiretroviral therapy (ART)
access, advocacy, and multi-disciplinary support services dramatically
increases demand for testing and counselling
HIV tests
Support groups
15,000
25
12,000
20
9,000
15
6,000
10
3,000
5
0
1998
Before ART
2002
ART started
Source: WHO, 2004 (courtesy of Dr. Fareed Abdullah)
2004 Report on the Global AIDS Epidemic (Fig 27)
0
1998
2002
Opportunities
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Pledges and contributions received,
as of December 31, 2003
EC
11%
France
14%
Italy
9%
U.S.
33%
Germany
7%
Italy
10%
Germany 2%
U.S.
30%
U.K. 6%
Japan Other
8% Govt’s
10%
Netherlands 2%
U.K.
6%
Netherlands 3%
France 6%
EC
19%
Canada 2%
Other
Japan Govt’s
7%
5%
Corporate/Private* 5%
Corporate/Private* 2%
Canada 2%
Total pledges:
Total contributions received:
US$ 4,966 million
US$ 2,104 million
*Foundations and Non-for-profit organizations, Corporations, and Individuals, Groups and Events
Source: THE GLOBAL FUND ANNUAL REPORT 2003, January 1 - December 31, 2003.
2004 Report on the Global AIDS Epidemic (Fig 42)
Opportunities
Treatment Works
Dec 2002
Mar 2003
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
What is 3by5
•
•
•
•
Target and goal
Strategic Areas
Funding requirements
Approach
– Role of AMDS
– Role of EDM
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
The "3 by 5" Target, what and why?
• 38 million people living with HIV/AIDS worldwide
• 6 million people are in need of antiretroviral treatment (ART)
• 440,000 people have access to treatment
• 3 million people die every year because they can not get the
treatment
• ART prolongs lives of people with HIV/AIDS enabling them to lead
a productive life.
• ART makes HIV/AIDS a chronic and manageable disease, not a
death sentence.
The Goal: Provide access to treatment for all
The Target: Treat 3 million people with AIDS, by the end
of 2005
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
"3 by 5" Strategic Areas
• Providing simplified and standardized tools and
guidelines on antiretroviral treatment
• Creating AMDS - AIDS Medicines and Diagnostics
Service to ensure effective and reliable supply of
medicines and diagnostics
• Rapid identification, dissemination and application of
new knowledge and successful strategies
• Urgent and sustained technical support to countries
• Providing assistance to countries for capacity building
and training
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
A Simple Two-Pronged Approach
Country Driven
• Scale-up & treatment happens in country. It is country driven
• Government are responsible for the care and treatment of their citizens,
including the poor and marginalized
• Multiple actors are involved in ART and with scale-up
• WHO provides technical support to governments
• Focus on UNAIDS "Three Ones" approach
 One National Plan
 One Coordinating Body
 One Monitoring and Evaluation System
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
A Simple Two-Pronged Approach
Simplification
• Simplified treatment
• Limited number of first line treatments
• Fixed Dose Combination (FDC) support adherence
• Simplified procurement and supply management
•Help countries streamline procurement and supply (AMDS)
•WHO Procurement, Quality and Sourcing Project (pre-qualification)
•E-procurement
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
AMDS in Focus
A project of UNAIDS, WHO, UNICEF the World Bank and other partners
A network for support in:
• Strategic information
e.g. on sources, prices, raw materials,
patent status
• Developing Stockpiles and pooled procurement
• Demand forecasting
• Technical support for product selection, procurement,
supply-management and local production
• Prequalification of ARVs and diagnostics
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
AMDS Secretariat
• Clearinghouse on ARV drugs and HIV diagnostics.
• Brokerage of collaboration between partners and
countries (or organizations in countries ).
• Support collaboration between partner organizations.
• Fundraise for AMDS activities by all partners.
• Advocate for investment in PSM, as a critical element for
the fight against AIDS
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
Partners so far
• Informal partners group
– UN Agencies
• WHO (EDM, EHT, CPS, Regional offices), UNICEF, World Bank,
UNAIDS, UNFPA, UNDP
– Technical organizations and donor agencies
• JSI, IDA, GFATM, MEDS, EPN, CHAI, Crown Agents
– Observers
• MSF, US State Department ( PEPFAR), USAID
– Secretariat
• AMDS unit of HIV Department of WHO
– New offers for collaboration
• CCAR, FIP, CPA
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
EDM
Selected areas of (in)direct importance to HIV (1)
• Country support
– Essential Medicines Programmes in 110 countries
– NPOs in 40 countries
• Training
– RDU (professional and in community)
– National regulatory agencies and drug quality control
laboratories
– Best practices in supply and distribution systems
– Pharmacovigilance
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
EDM
Selected areas of (in)direct importance to HIV (2)
• Evidence based tools, guidelines, TA
–
–
–
–
Model list of Essential Medicines
FDCs
Pharmacopoeal monographs
TRIPs-compatible legislation
• Strategic information
– Prequalification project
– Sources and prices and pricing studies
World Health Organization
"3 by 5" Target
http://www.who.int/3by5
"3 by 5"
Make It Happen
For further information……….
Peter Graaff
[email protected]
World Health Organization
"3 by 5" Target
http://www.who.int/3by5