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This document is a discussion paper, prepared for the 2012 InternationalAIDS Conference in Washington DC, United States of America. It highlights key issues that confront the global community, policy-makers and national programme planners as they seek to make optimal use of antiretroviral drugs (ARVs) as part of the broader response to HIV.
It also discusses how ARVs could contribute to eventually ending the HIV epidemic. The paper does not in itself constitute a World Health Organization (WHO) guidance document, even though it summarizes existing WHO guidelines related to ARV use, highlights progress in the Treatment 2.0 initiative, and summarizes the next steps in WHO’s normative work related to ARV use.
Resource | Publications,
The U.S. Government (USG) and U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) have demonstrated a strong commitment to addressing the global HIV epidemic and to reaching most-at-risk populations (MARPs), also increasingly referred to as key populations. In order to successfully impact the epidemic of HIV among these populations, access to a comprehensive package of integrated services must be provided for men who have sex with men (MSM) and transgendered persons (TG). The act of Congress reauthorizing PEPFAR (July 2008) provides support for appropriate HIV education programs targeted to prevent HIV transmission among MSM as well as evaluation of the effectiveness of prevention efforts among MSM (Lantos and Hyde 2008).
To support these goals as part of PEPFAR’s comprehensive HIV prevention strategy, in May 2011, PEPFAR issued a Technical Guidance on Combination HIV Prevention document for MSM. This document responds directly to the urgent need to strengthen and expand HIV prevention for MSM and their partners and to improve the ability of MSM to access HIV care and treatment.
Resource | Publications,
At the end of 2011, more than 8 million people were receiving antiretroviral therapy in low- and middle-income countries, a dramatic 26-fold increase from December 2003. Although it can be minimized, some degree of HIV drug resistance is anticipated to emerge among people on treatment even when appropriate antiretroviral therapy is provided and high levels of adherence are achieved. Therefore, WHO initiated global surveillance of HIV drug resistance in 2004 in order to adequately monitor the emergence of HIV drug resistance as countries scaled up access to antiretroviral therapy.
Although HIV drug resistance data from low- and middle-income countries are increasingly available, lack of surveillance data over time substantially limits the ability to assess trends in these countries. As ART coverage continues to grow, national programmes should perform routine surveillance of transmitted and acquired HIV drug resistance to optimize programme planning and management and to inform antiretroviral therapy policy.
Resource | Publications,
The Global Price Reporting Mechanism (GPRM) contains information on transaction prices, sources and quantities of antiretroviral medicines (ARVs), tuberculosis and malaria drugs and HIV/AIDS, tuberculosis and malaria diagnostics purchased by HIV/AIDS, tuberculosis and malaria programmes in low-income countries1, lower middle-income countries2 and upper middle-income countries. Countries have been classified according to the World Bank Atlas calculation method.
Resource | Presentations,
Getting to Zero in Asia and the Pacific: Focus and Innovation
UNAIDS Regional Management Meeting October 29, 2012
Resource | Publications,
Now is a critical time to ensure widest possible access to ART: a landmark scientific breakthrough in 2011 showed that treatment with antiretroviral medicines (ARVs) not only saves lives, but can also stop HIV from being transmitted by up to 96%. In response to this evidence, in 2012 the World Health Organization (WHO) issued guidance supporting immediate treatment – regardless of a person’s immune system’s status or CD4 count – for HIV-positive people who have HIV-negative partners, in order to help prevent transmission of the virus.5 At the same time, guidance was also issued suggesting the possibility of offering full antiretroviral therapy for life to all pregnant women living with HIV for prevention of mother-to-child transmission of the virus (PMTCT).
Resource | Publications,
In 2010, an estimated 34 million people were living with the human immunodeficiency virus (HIV), around 70% of them in sub-Saharan Africa. By the end of 2010, 6.6 million people, or 47% of those in need (CD4+ cell count <350 cells/mm3), were on antiretroviral therapy (ART), and an estimated 7.5 million people were still in need of treatment. While considerable progress has been made in extending ART coverage, there continue to be critical gaps. In the same year, coverage for children was reported to be less than 23%, there were 2.7 million new infections and more than 20 million people were not yet treatment-eligible (as most of them did not know their HIV status). There were an estimated 1.1 million new cases of HIV-associated tuberculosis (TB), which led to 24% of HIV-related deaths. HIV is the strongest risk factor for developing TB, and people living with HIV have a 20–37 times higher risk of developing TB than those who do not. ART has a significant secondary prevention benefit for both HIV and TB, and expanded access to ART has probably averted millions of HIV infections and cases of TB.
The World Health Organization (WHO) has introduced the concept of HIV elimination through the use of combination prevention and prevention of mother-to-child transmission (PMTCT) of HIV. Additionally, WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched Treatment 2.0 to look at ways to provide better services to a larger number of persons at lesser cost, and in a way that helps to retain them on lifelong ART. This would also greatly benefit HIV prevention efforts.
Resource | Presentations,
Presentation on Flexibilities before the grant of a patent: Introduction to patentability criteria and flexibilities at Regional Consultation and Planning Workshop "Use of TRIPS Flexibilities to Access Affordable ARVs in Asia" Bangkok 29-31 May 2012
Resource | Presentations,
Presentation on Patent Oppositions and Strict Patentability Criteria: What it Means for Access to Treatment? at Regional Consultation and Planning Workshop “Use of TRIPS Flexibilities to Access Affordable ARVs in Asia” Bangkok 29-31 May 2012