The ambitious global target to enrol three million people on antiretroviral treatment by the end of 2005 is not likely to be reached until midway through 2006, the World Health Organisation (WHO) admitted today on the release of its `3 x 5` progress report.
So far one million people have been enrolled on treatment.
Last July WHO said that it thought progress was on track to reach the three million target by the end of 2005, but now admits that efforts are falling way behind target. Dr Jim Kim of WHO said today that he hoped that the target would be reached during 2006, and that WHO would not be setting a new target, but that it will continue to support countries to reach their individual targets.
However Ties Boerma of WHO said that it is plausible that with one million people already on treatment, death rates might begin to stabilise or fall in some countries by the end of the year, given the experience of countries in the developed world after the introduction of protease inhibitors.
WHO blames lack of human resources at country level, problems in getting drugs to where they are needed and problems in co-ordination of treatment programmes at country level for the slow progress, but also highlights lack of political will in some countries.
“I don’t think that any of us imagined that supply chain management would become such an issue,” said Dr Jim Kim of WHO. “For many countries the volume of antiretrovirals they are handling is more than they have been used to [in any other area]. The problems are at all levels. If we had been involved in technical assistance for supply chain management two years ago we’d be much further along.”
The numbers receiving treatment have increased threefold in sub-Saharan Africa in the past year, with 500,000 now thought to be on treatment. However WHO estimates that 4.7 million people need treatment already in sub-Saharan Africa, indicating that antiretrovirals are reaching only eleven per cent of those who need them. Similar levels of coverage have been achieved in other regions of the world, with the exception of Latin America, where antiretrovirals are estimated to have reached 62% of those who need them.
Although there appears to be equity in treatment access between men and women, children are still under-represented amongst those on treatment, WHO says.
A total of 660,000 children worldwide need access to antiretroviral therapy in 2005, whilst four million, of whom 3.5 million live in sub-Saharan Africa, may need cotrimoxazole prophylaxis. Early diagnosis of HIV infection in children, WHO says, could reduce the total number needing prophylaxis to 2.1 million, since diagnosis would avoid the need for presumptive treatment in uninfected children.
Estimates of numbers treated have been compiled with the help of the United States' President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, as well as country reports. WHO says that the figures are accurate to within 5 to 25% for most countries.