UNAIDS today called for a radically simplified approach to antiretroviral therapy in order to maximise the prevention benefits of HIV treatment, labelling the approach `Treatment 2.0`.
In a report issued ahead of the Eighteenth International AIDS Conference in Vienna, which takes place between July 18th and 23rd, UNAIDS says that a successful transition to a `Treatment 2.0` mode of managing HIV disease could avert 10 million AIDS deaths by 2025 and one million new infections each year.
Treatment 2.0 will require progress in five areas, said Michel Sidibé, executive director of UNAIDS:
- A once-daily fixed dose combination that is less toxic, less vulnerable to resistance if treatment is missed, and which could be managed without laboratory monitoring, together with simple point-of-care diagnostics that would allow HIV treatment to be monitored at any health facility.
- Maximising access to treatment for everyone in current medical need, in the expectation that as in recent cohort studies in Africa, treatment will greatly reduce the number of new infections.
- Reduce the cost of treatment, especially the non-drug-associated costs like monitoring, staffing and hospitalisation of people who start treatment very late. (Up to 80% of the cost of treatment may be non-drug-associated, UNAIDS claims, although recent studies have found wide variations according to the country examined).
- Maximise the uptake of HIV testing so that people can be diagnosed earlier and start treatment earlier. This will have an impact on both deaths and new infections, and increase life expectancy.
- Strengthen community mobilisation: by involving the community in managing treatment programmes, treatment access and adherence can be improved. Demand creation will also help bring down costs for extensive outreach and help reduce the burden on health care systems.
New data supporting some of these approaches will be presented at next week’s International AIDS Conference, but the chief question about the long-term impact of this approach remains how many infections will be prevented by antiretroviral treatment.
UNAIDS estimates that new HIV infections could be reduced by one-third worldwide, but there is disagreement among epidemiological modellers regarding the impact of wider treatment according to current guidelines, with one group suggesting that in some circumstances, wider treatment according to current guidelines might have little net benefit in cost-effectiveness terms, because the reduction in infections would be insufficient to offset the additional costs of treatment.
HIV prevalence declining among young people in worst-hit countries
UNAIDS also released new information on HIV prevalence trends among young people in countries with a high burden of HIV infection, showing that HIV prevalence among young people has declined by more than 25% in 15 of the 25 countries most affected by AIDS. These declines are largely due to falling new HIV infections among young people.
In eight countries—Côte d’Ivoire, Ethiopia, Kenya, Malawi, Namibia, the United Republic of Tanzania, Zambia and Zimbabwe—significant HIV prevalence declines have been accompanied by positive changes in sexual behaviour among young people.
For example, in Kenya there was a 60% decline in HIV prevalence between 2000 and 2005. HIV prevalence dropped from 14.2% to 5.4% in urban areas and from 9.2% to 3.6% in rural areas in the same period. Similarly in Ethiopia there was a 47% reduction in HIV prevalence among pregnant young women in urban areas and a 29% change in rural areas.
Young people in 13 countries, including Cameroon, Ethiopia, and Malawi, are waiting longer before they become sexually active. Young people were also having fewer multiple partners in 13 countries. And condom use by young people during last sex act increased in 13 countries.
There are 5 million young people living with HIV worldwide, making up about 40% of new infections.
Investments need to be sustained but money must be better spent, says UNAIDS
“The AIDS response needs a stimulus package now. Donors must not turn back on investments at a time when the AIDS response is showing results,” said Mr Sidibé. “The 0.7% target on international aid and the Abuja target of 15% for health cannot be buried.”
UNAIDS recommends that national HIV programmes invest between 0.5% and 3% of government revenue in the AIDS response. In recent years many countries have increased their domestic investments in the AIDS response. For example, the South African Government increased its budget for AIDS by 30% to US$ 1 billion in 2010. However, for the majority of the countries severely affected by AIDS, domestic investments alone, even when raised to optimal levels, will not suffice to meet all their resource needs.
UNAIDS called on richer developing countries to meet a substantial proportion of their resource needs from domestic sources. Currently, 50% of the global resources requirement for low- and middle-income countries is in 68 countries where the national need is less than 0.5% of their gross national income. These countries have 26% of the people living with HIV and receive 17% of international assistance for AIDS.
According to the report, current investments in HIV can become more efficient, effective and predictable. “We can bring down costs so investments can reach more people,” said Mr Sidibé. “This means doing things better—knowing what to do, channelling resources in the right direction and not wasting them, bringing down prices and containing costs. We must do more with less.”
Adapted from UNAIDS press release