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November 6, 2012 1 | YVES SOUTEYRAND WHO, HIV/AIDS DEPARTMENT, GENEVA Towards Universal Access: progress and challenges
November 6, 2012 1 |
YVES SOUTEYRAND
WHO, HIV/AIDS DEPARTMENT, GENEVA
Towards Universal Access:
progress and challenges
November 6, 2012 2 |
Contents
The global epidemic
ART and PMTCT: progress in the response
Key challenges towards Universal Access
November 6, 2012 3 |
• Including 3.4 million children less than 15 years
• 2.5 millions new infections (including 330 000 children);
16% less than in 2001
• 1.7 million people died of AIDS in 2011 (2.3 million in 2005)
• Each day 6 850 people newly infected
• Each day 3 850 more people on Antiretroviral Therapy
Globally, 34.2 million people living with HIV in 2011
November 6, 2012 4 |
People living with HIV
40 000 000
30 000 000
20 000 000
10 000 000
0
People
People living with HIV
35 000 000
25 000 000
15 000 000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
5 000 000
November 6, 2012 5 |
New HIV infections and AIDS-related deaths
4 000 000
3 000 000
2 000 000
1 000 000
0
People
New HIV infections
3 500 000
2 500 000
1 500 000
500 000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
AIDS-related deaths
Globally new HIV infections peaked in 1997
November 6, 2012 7 |
Commitments and targets for 2015
November 6, 2012 8 |
Number of people receiving
antiretroviral therapy, 2002-2011
November 6, 2012 9 |
Antiretroviral therapy coverage in low- and middle-
income countries, all ages, 2010-2011
WHO region
Reported number of
people receiving ARV
therapy
Estimated number of
people needing ARV
therapy
Antiretroviral
therapy
coverage
2011 2010 2011 2010 2011 2010
African region 6 180 000 5 062 000 10 900 000 10 400 000 57% 49%
Region of the Americas 580 000 521 000 850 000 820 000 68% 63%
Eastern Mediterranean region 20 300 15 200 200 000 190 000 10% 8%
European region 137 000 123 000 520 000 495 000 26% 25%
South-East Asia region 840 000 717 000 1 800 000 1 800 000 46% 40%
Western Pacific region 260 000 203 000 540 000 500 000 48% 40%
Total 8 020 000 6 640 000
14 800 000
[13.7–15.6
million]
14 200 000
[13.2–15.0
million]
54% [51–
58%]
47% [44–
50%]
November 6, 2012 10 |
E-MTCT targets
Indicator Baseline 2009 Target
Maternal ARV
prophylaxis coverage 48% 90%
ART coverage for
pregnant women 34% 90%
Breastfeeding ARV
coverage
N/A 90%
ART for children 21% 100%
New paediatric
infections 429 000 <43 000
Deaths due to HIV
among children < 5 162 000 <81 000
November 6, 2012 11 |
Coverage of antiretroviral medicine for preventing mother-to-child
transmission in low- and middle-income countries, by region, 2011
November 6, 2012 12 |
Antiretroviral therapy coverage in low- and middle-
income countries among children, 2010-2011
WHO region
Reported number of
children receiving ARV
therapy
Estimated number of
children needing ARV
therapy
Antiretroviral
therapy
coverage
among
children
2011 2010 2011 2010 2011 2010
African region 495 700 387 500 1 810 000 1 820 000 27% 21%
Region of the Americas 17 000 16 300 39 300 41 300 44% 39%
Eastern Mediterranean region 1 000 860 21 300 20 100 5% 4%
European region 8 200 7 300 7 800 7 000 >95% >95%
South-East Asia region 33 700 34 000 86 300 85 200 39% 40%
Western Pacific region 10 700 9 700 23 000 22 100 46% 44%
Total 566 100 456 000
2 000 000
[1.8–2.3
million]
2 000 000
[1.8–2.3
million]
28% [25–
31%]
23% [20–
25%]
November 6, 2012 15 |
Low-income Lower middle-
income
High-income Upper middle-
income
Year of starting ART
Mean
CD
co
un
t (c
ell
s/µ
L)
Estimates from random-effects
model adjusted for age, sex and
year of starting ART, 2002-2009
Mean CD4 count at ART initiation is below 200 in LMIC
Source: Egger M. CROI 2012
2002 2009 2002 2009 2002 2009 2002 2009
November 6, 2012 18 |
The test-treat-retain cascade
Create demand for testing and treatment
Testing
+
Pre-ART care and support
ART
Adherence and viral
suppression
ART eligible
HIV+
November 6, 2012 19 |
100%
59%
27%18%
Retention: from testing to treatment
• Significant loss of follow-up
in test-to-treat chain
• Still, 30-70% of PLWH
unaware of their HIV status
• WHO strategic framework
on mix of testing
approaches (end 2012)
Rosen et al, Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review, 2010
November 6, 2012 20 |
Retention rates for ART at 12, 24 and 60 months
in selected countries, 2011
84%
78% 72%
November 6, 2012 21 |
Conclusions
Global progress in scale-up of ART has been extraordinary as well as the impact
on the epidemic
Further scale-up must address disparities and inequities
With new evidence and new policies, the number of people eligible for ART will
increase
It is the moment to think and plan beyond the 15 million target
This requires forward-looking policies, more effective and innovative approaches,
together with further investments
