world health organization "3 by 5" target access to hiv/aids medicines the 3x5 strategy...

World Health Organization

"3 by 5" Targethttp://www.who.int/3by5

Access to HIV/AIDS Medicines The 3x5 strategy

WHO/EDM Technical Briefing Seminar



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 ?



Challenges

Magnitude

• Numbers

• Treatment gap

• Cost

• Capacity required



GlobalGlobal AIDS epidemic AIDS epidemic 19901990−−2003 2003

0

10

20

30

40

50

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Mill

ions

Number of people living with HIV and AIDS

0.0

1.0

2.0

3.0

4.0

5.0

Year

% HIVprevalence adult (15-49)

Source: UNAIDS/WHO, 2004

Number of people living with HIV and AIDS

% HIV prevalence, adult (15-49)

2004 Report on the Global AIDS Epidemic (Fig 1)

Challenges

00003-E-5 – July 2004

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

Challenges

00003-E-6 – July 2004

Global summary of the HIV and AIDS

epidemic, December 2003

The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.

Number of people living with HIV 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)

People newly infected with HIV in 2003 Total 4.8 million (4.2 – 6.3 million)


Children under 15 years 630 000 (570 000 – 740 000)

AIDS deaths in 2003 Total 2.9 million (2.6 – 3.3 million)


Children under 15 years 490 000 (440 000 – 580 000)

Challenges

Yearl

y d

eath

s as

a f

act

or

of

tota

l in

1

99

5

0.0

0.5

1.0

1.5

2.0

Introduction of Highly Active Antiretroviral Treatment

(HAART)

AIDS Deaths in Africa

AIDS Deaths in Western Europe

19921991 19991993 19951994 1996 1997 20011998 2000

Source: Adapted from WHO/UNAIDS Statistics & HIV/AIDS Surveillance in Europe, End-year report 2001, No 66, CESES

Widening Gap of AIDS TreatmentWidening Gap of AIDS Treatment

2003

Challenges

400,000 people on treatment: 7% coverage

0

10

20

30

40

50

60

%


Antiretroviral therapy coverage for adults,

end 2003

Africa Asia Latin America and the Caribbean

Eastern Europe and Central Asia

North Africa and Middle East


Challenges



High burden countries in need of ART, Nov 2003

High burden countries in need of ART, Nov 2003

0

5,000

10,000

15,000

20,000

2004 2005 2006 2007

Latin America and the Caribbean

Eastern Europe and Central Asia

North Africa and Middle East

East Asia and the Pacific

South and South-East Asia

Sub-Saharan Africa

Source: UNAIDS, 2004

Projected annual HIV and AIDS financing needs

by region, 2004−2007 (in US$ million)

US

$ m

illion

s


Challenges



Opportunities

Shifts

• Political will

• Prices

• Positive stories

• "Pecunia"


2 000

4 000

6 000

8 000

10 000

12 000

14 000

0

Pri

ce U

S$

Jun00

Oct00

Feb01

Apr01

Dec00

Nov00

Jul01

Mar03

Sep98

Aug98

Jul98

Oct03

Jun98

Sep03

Jan01

May01

Aug01

Mar10

Jun01

Launch of Acceleratin

g

Access Initia

tive (A

AI)

Negotiatia

tions with

R & D Pharma with

in AAI

Generic companies’ o

ffer of p

rice re

duction to

Uganda

Further p

rice re

ductions by AAI companies

Further d

iscussion with generic

companies

Negotiatio

ns by Willia

m J. Clinton

Foundation with

4 generic companies

Mar01

Apr01

Oct03

Jun01

May01

Feb01

Jan01

Dec00

Nov00

Jul01

600700800900

1 0001 1001 200

500

Pri

ce U

S$

400300200100

0

Prices (US$/year) of a first-line antiretroviral regimen in Uganda: 1998−2003


Opportunities

0

3,000

6,000

9,000

12,000

15,000

1998

Before ART

2002

ART started

0

5

10

15

20

25

1998 2002

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

Source: WHO, 2004 (courtesy of Dr. Fareed Abdullah)


Opportunities

The Global Fund to Fight AIDS, Tuberculosis and Malaria

Pledges and contributions received, as of December 31, 2003

EC11%

Italy9%

Germany7%

U.K.6%

OtherGovt’s

7% Japan5%

Netherlands 3%

Canada 2%Corporate/Private* 2%

France14%

U.S.33%

EC19%

Italy10%

Germany 2%U.K. 6%

OtherGovt’s10%

Japan 8%

Netherlands 2%

Canada 2%

Corporate/Private* 5%

France 6%

U.S.30%

Total pledges:

US$ 4,966 millionTotal contributions received:

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.


Opportunities



Treatment WorksTreatment Works

Dec 2002Dec 2002 Mar 2003Mar 2003

Opportunities



What is 3by5

• Target and goal

• Strategic Areas

• Funding requirements

• Approach– Role of AMDS– Role of EDM



• 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 "3 by 5" Target, what and why?

The "3 by 5" Target, what and why?

The Goal: Provide access to treatment for allThe Target: Treat 3 million people with AIDS, by the end

of 2005



"3 by 5" Strategic Areas"3 by 5" Strategic Areas

• Providing simplified and standardized toolssimplified and standardized tools and guidelines on antiretroviral treatment

• Creating AMDS - AIDS Medicines and AMDS - AIDS Medicines and Diagnostics ServiceDiagnostics Service to ensure effective and reliable supply of medicines and diagnostics

• Rapid identification, dissemination and application of new knowledge and successful new knowledge and successful strategiesstrategies

• Urgent and sustained technical support to support to countriescountries

• Providing assistance to countries forProviding assistance to countries for capacity capacity building and trainingbuilding and training



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



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



AMDS in FocusAMDS 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



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



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



EDMSelected 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



EDMSelected 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



"3 by 5""3 by 5"

Make It HappenMake It Happen

For further information……….

Peter Graaff

[email protected]

world health organization "3 by 5" target access to hiv/aids medicines the 3x5 strategy...

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