Taking the Pulse:Global Update on the Health Sector Response to HIV, 2014Dr Gundo WeilerCoordinator Strategic InformationHIV DepartmentWorld Health Organization

WHO Satellite at AIDS2014, 20 July 2014

Global Health Sector Strategy on HIV/AIDS 2011-2015- a new health sector agenda for HIV/AIDS

Leverage broader health outcomes through HIV/AIDS responses

Reduce vulnerabilities and remove structural access barriers

Build strong and sustainablehealth systems

Optimize HIV prevention, diagnosis, treatment and care ❷

❸

❶

❹

Gauging recent progress in the global HIV response

2.1 million HIV infections ▼ 15%

240 000 HIV infections in children ▼ 40%

1.5 million HIV related deaths ▼ 25%

320 000 TB-related deaths in PLWHA* ▼ 36%** *2012 ** 2004-2012

[1.9 – 2.5 million]

[1.4 – 1.7 million]

[210 000 – 280 000]

[300 000 – 340 000]

2013 2009-2013

Outline

01 | Prevention, diagnosis, treatment and care

ART

PMTCT

Prevention

02 | Service integration

03 | Systems strengthening

04 | Removing structural barriers

Methodology

Global AIDS Response Progress Reporting (GARPR)

• Annual reporting of programme data by countries (MoH, NAPs), electronic platform managed by UNAIDS, validated jointly by WHO, UNICEF, UNAIDS

• By June 2014, 131 out of 144 low- and middle income countries provided ART data, representing 99% of estimated total number of people on ART at end of 2013

Country policies and practices

• Real-time tracking of implementation of HIV health sector policies in practices in 58 focus countries, including UBRAF high impact countries and Global Plan countries

• Country submission through GARPR and validation/completion by WHO in-country staff.

12,9 million people on ART at the end of 2013 globally. 11,7 in low-and middle income countries - 2 million more than at the end of 2012Actual and projected numbers of people receiving antiretroviral therapy in low-and middle-income countries, and by WHO Region, 2003–2015

Source: 2014 Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS).

Catalyse HIV treatment, care and support

Africa, with most people living with HIV, continues to drive global scale-up, but low-coverage Regions are catching up

Catalyse HIV treatment, care and support

Total: 11.7 million in LMIC36%

788 00044%

9 100 00037%

28 00010%

254 00022%

402 00032%

1 100 00033%

Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

Global scale-up driven by large increases in ART for adults

Adults

9,0 m

10,9 m+ 21%

> 1 in 3 adults with HIV on ART (37%)

Catalyse HIV treatment, care and support

Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

The gap between access to ART for children and adults continues to widen

Adults

Children

9,0 m

740 k

10,9 m

640 k

+ 21%

+ 15%1 in 4 children with HIV on ART (23%)

Catalyse HIV treatment, care and support

> 1 in 3 adults with HIV on ART (37%)

Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

HIV has become the 2nd biggest cause of death for adolescents globally

Catalyse HIV treatment, care and support

Source: Health of the world’s adolescent, WHO 2014

Access to ART for people who inject drugs remains insufficient, the example of Eastern Europe

PWID among all

PLWHA

PWID among all on ART

People who inject drugs as aproportion of all people living with HIVwith a known transmission route and The proportion of people who inject drugs Who received antiretroviral therapy in reporting countries, WHO European Region

Catalyse HIV treatment, care and support

Outline

01 | Prevention, diagnosis, treatment and care

ART

PMTCT

Prevention

02 | Service integration

03 | Systems strengthening

04 | Removing structural barriers

05 | Looking ahead

Close to 1 million pregnant women received ARVs, 500,000 still being missed

Eliminate new HIV infections in children

2005 2006 2007 2008 2009 2010 2011 2012 2013 0

200 000

400 000

600 000

800 000

1 000 000

1 200 000

1 400 000

1 600 000

1 800 000

2 000 000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 640 0001 540 000

1 450 000

220 000

730 000

966 000

13%

47%

67%

Number of pregnant women living with HIV needing ARV medicines for PMTCTRangesSeries3Number of pregnant women living with HIV receiving any ARV medicines for PMTCTPercentage coverage

Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

Source: Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS) and 2013 UNAIDS estimates.

Reaching the global target will depend on progress in some high burden countries with persisting low coverage

Democratic Republic of the Congo

Ethiopia

Cameroon

Malawi

Zimbabwe

Zambia

Kenya

Mozambique

United Republic of Tanzania

Uganda

Nigeria

South Africa

0 50 000 100 000 150 000 200 000 250 000 300 000

33%55%61%

79%78%

76%63%

84%73%

75%27%

90%

Number of pregnant women living with HIV receiving ART medicines for PMTCT (Option A, B and B+)Total number of pregnant women living with HIV (all needing PMTCT ARVs)

Eliminate new HIV infections in children

Tanzania

DR of the Congo

Eliminate new HIV infections in children

Steady increase in roll-out of Early Infant Diagnosis, but still too few exposed children tested

2011 20130%

10%20%30%40%50%60%70%80%90%

100%

34% 43%

Pooled coverage of EID in 88 countries with data from 2011 and 2013

Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS)

Outline

01 | Prevention, diagnosis, treatment and care

ART

PMTCT

Prevention

02 | Service integration

03 | Systems strengthening

04 | Removing structural barriers

05 | Looking ahead

Key populations are disproportionally affected by HIV, and disturbing news on outbreaks across all regions

Average HIV prevalence in key population surveys and general population

Invigorate HIV Prevention

Source: Unpublished literature review based on 88 country studies, 2007-2013

SW MSM TG PWID0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

1.00% 1.20% 0.60% 0.70%

23.00%

16.00%

23.00%

19.00%

General population prevalenceKey population prevalence

Sex worker

Men who havesex with men

Transgenderpeople

People whoinject drugs

But still glaring gaps in addressing the needs of key populations in national HIV plans

MSM

Transge

nder people

Sex w

orkers

PWID

Prisoners

0%

20%

40%

60%

80%

100%

71%

28%

62%40% 52%

29%

72%

38%60% 48%

not addressedaddressed

Percentage of 58 WHO HIV Focal Countries with explicit reference to specific key populations in their national HIV/AIDS Plan, June 2014

Invigorate HIV Prevention

Invigorate HIV Prevention

VMMC increased by 50% in 2013 to a total of 5.8 million, but its full potential is far from being exhausted

Outline

01 | Prevention, diagnosis, treatment and care

ART

PMTCT

Prevention

02 | Service integration

03 | Systems strengthening

04 | Removing structural barriers

05 | Looking ahead

Accelerating increase in ART coverage among notified TB patients to 70%Percentage of people coinfected with HIV and notified TB who initiated ART, 2007–2013

Service Integration

Source: provisional data from the Global Tuberculosis Programme Database, June 2014

85% of all ANC attendees were tested for syphilis - countries are targeting dual elimination

Service Integration

Percentage of antenatal care attendees tested for syphilis at first visit, 2012

Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS)

HIV is supporting an emerging hepatitis agenda

HBV HCV testing HBV vaccination HCV treatment0%5%

10%15%20%25%30%35%40%45% 41%

21%14%

Service Integration

Share among 58 WHO HIV focus countries offering hepatitis services in ART clinics, June 2014

Source: WHO HIV Country Intelligence Database, June 2014

Outline

01 | Prevention, diagnosis, treatment and care

ART

PMTCT

Prevention

02 | Service integration

03 | Systems strengthening

04 | Removing structural barriers

05 | Looking ahead

Prices continue to decrease, but stockouts remain of concern

Median prices of WHO-preferred first-line regimens per person per year, in US dollars, in low-and middle-income countries, 2004–2013

Systems Integration

In multiple countries laws, regulations or policies exist that can hinder service provision for key populations

Human Rights and Access Barriers

47%

53%

43%

MSMSexworkers

PWID

Source: GARPR 2013 – “Countries reporting existence of laws, regulations or policies that can pose obstacles to effective HIV prevention, treatment, care and support services for key populations”

Outline

01 | Prevention, diagnosis, treatment and care

ART

PMTCT

Prevention

02 | Service integration

03 | Systems strengthening

04 | Removing structural barriers

05 | Looking ahead

Rapid uptake of 2013 ARV guidelines increases eligibility

ART in liver disease

ART in SD couples

PMTCT Option B+

Paediatic ART <5 years

Adult initiation <CD 500

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

40%

48%

45%

39%

52%

Percentage of 58 WHO HIV Focal Countries with confirmed adoption of select WHO 2013 ARV recommendations, June 2014

_

* or 75% of 22 EMTCT Global Plan countries

*

Source: WHO HIV Country Intelligence Database, June 2014

Ending the AIDS epidemic by 2030

Source: UNAIDS estimates (2014), Gap report

Child – adult coverage gap is widening

Rapid uptake of new guidance, innovation is driving country responses

New eligibility criteria call for new ambitious treatment targets

Conclusions: Main figures and messages

12.9 million on ART globally, record 2 million increase in 2013

740 000 children on ART, only 15% more than in 2012

40-50% of countries have adopted 2013 ARV guidelines

HIV response blazes the trail for universal health coverage

Consolidation around integrated [HIV] service packages

Failure in reaching key populations

Since 2009, 25% drop in mortality, but only 15% drop in incidence

Acknowledgements• Countries: Ministries of Health and National AIDS Programmes from 181 countries• WHO: Andrew Ball, Txema Calleja, Michel Beusenberg, Chika Hayashi, Theresa

Babovic (cons.), Hein Marais (cons.), Isabel Bergeri, Gottfried Hirnschall, Meg Doherty, Rachel Baggaley, Jos Perriens, Marco Vitoria, Nathan Shaffer, Vincent Habiyambere, Boniface Dongmo, Eyerusalem Negussie, Martina Penazzato, Tunga Namjilsuren, Haileyesus Getahun, Annabel Baddeley, Emil Asamoah Odei, Frank Lule, Ying-Ru Lo, Dongbao Yu, Amaya Maw, Massimo Ghidinelli, Monica Alonso, Gabriele Riedner, Hamida Khattabi, Martin Donoghoe, Irina Eramova, Annemarie Stengaard

• UN organizations: Peter Ghys, Mary Mahy (UNAIDS); Craig McClure, Chewe Luo, Priscilla Idele, Rosalind Carter (UNICEF)

• Partners: Lara Stabinski (OGAC); Laura Porter, John Aberle-Grass (CDC); Chris Duncombe (BMGF); Alvaro Bermejo, Gitau Mburu (AIDS Alliance); Asia Russell (HealthGAP); Tony Harries (Union); Ade Fakoya (GFATM); Mark Harrington (TAG); Vincent Wong (USAID); Tim Hallet (Imperial College); Tsehaynesh Messele (ASLM)