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Jul. 16, 2019


UNAIDS calls for greater urgency as global gains slow and countries show mixed results towards 2020 HIV targets

Impressive advances in some countries, troubling failures in others as available resources for HIV fall by nearly US$ 1 billion

ESHOWE/GENEVA, 16 July 2019—The pace of progress in reducing new HIV infections, increasing access to treatment and ending AIDS-related deaths is slowing down according to a new report released today by UNAIDS. UNAIDS’ Global AIDS Update, Communities at the centre, shows a mixed picture, with some countries making impressive gains while others are experiencing rises in new HIV infections and AIDS-related deaths.

“We urgently need increased political leadership to end AIDS,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible ifwe focus on people not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reaching people most affected by HIV.”

The report shows that key populations and their sexual partners now account for more than half (54%) of new HIV infections globally. In 2018, key populations—including people who inject drugs, gay men and other men who have sex with men, transgender people,sex workers and prisoners—accounted for around 95% of new HIV infections in eastern Europe and central Asia and in the Middle East and North Africa.

However, the report also shows that less than 50% of key populations were reached with combination HIV prevention services in more than half of the countries that reported. This highlights that key populations are still being marginalized and being left behindin the response to HIV.

Globally, around 1.7 million people became newly infected with HIV in 2018, a 16% decline since 2010, driven mostly by steady progress across most of eastern and southern Africa. South Africa, for example, has made huge advances and has successfully reducednew HIV infections by more than 40% and AIDS-related deaths by around 40% since 2010.

However, there is still a long way to go in eastern and southern Africa, the region most affected by HIV, and there have been worrying increases in new HIV infections in eastern Europe and central Asia (29%), in the Middle East and North Africa (10%) and inLatin America (7%).

The report was launched at a community event in Eshowe, South Africa, by Ms Carlsson and David Mabuza, the Deputy President of South Africa. It contains case studies and testimonies identifying community programmes that can quicken the pace of the responseto HIV.

“South Africa has a rich history of communities being at the centre of the AIDS response, so it is fitting that we launch the 2019 UNAIDS Global AIDS Update in this country, in Eshowe, in KwaZulu-Natal, where a community-based service delivery model, with HIVat its centre, is showing results,” said Deputy President Mabuza.

Financing

Disconcertingly, the report shows that the gap between resource needs and resource availability is widening. For the first time, the global resources available for the AIDS response declined significantly, by nearly US$ 1 billion, as donors disbursed less anddomestic investments did not grow fast enough to compensate for inflation. In 2018, US$ 19 billion (in constant 2016 dollars) was available for the AIDS response, US$ 7.2 billion short of the estimated US$ 26.2 billion needed by 2020.

To continue progress towards ending AIDS, UNAIDS urges all partners to step up action and invest in the response, including by fully funding the Global Fund to Fight AIDS, Tuberculosis and Malaria with at least US$ 14 billion at its replenishment in Octoberand through increasing bilateral and domestic funding for HIV.

Treatment and the 90–90–90 targets

Progress is continuing towards the 90–90–90 targets. Some 79% of people living with HIV knew their HIV status in 2018, 78% who knew their HIV status were accessing treatment and 86% of people living with HIV who were accessing treatment were virally suppressed,keeping them alive and well and preventing transmission of the virus.

Communities at the centre shows however that progress towards the 90–90–90 targets varies greatly by region and by country. In eastern Europe and central Asia for example, 72% of people living with HIV knew their HIV status in 2018, but just 53% ofthe people who knew their HIV status had access to treatment.

“I’ve been on treatment for 16 years, am virally suppressed and doing well,” said Sthandwa Buthelezi, founder of Shine, an organization in Eshowe that addresses stigma and discrimination in the community. “But stigma and discrimination are still widespread,particularly in health care settings. As an activist, I encourage everyone, including community leaders, to talk openly about HIV so that people can live positively and shine.”

AIDS-related deaths

AIDS-related deaths continue to decline as access to treatment continues to expand and more progress is made in improving the delivery of HIV/tuberculosis services. Since 2010, AIDS-related deaths have fallen by 33%, to 770 000 in 2018.

Progress varies across regions. Global declines in AIDS-related deaths have largely been driven by progress in eastern and southern Africa. In eastern Europe and central Asia however, AIDS-related deaths have risen by 5% and in the Middle East and North Africaby 9% since 2010.

Children

Around 82% of pregnant women living with HIV now have access to antiretroviral medicines, an increase of more than 90% since 2010. This has resulted in a 41% reduction in new HIV infections among children, with remarkable reductions achieved in Botswana (85%),Rwanda (83%), Malawi (76%), Namibia (71%), Zimbabwe (69%) and Uganda (65%) since 2010. Yet there were nearly 160 000 new HIV infections among children globally, far away from the global target of reducing new HIV infections among children to fewer than 40000 by 2018.

More needs to be done to expand access to treatment for children. The estimated 940 000 children (aged 0–14 years) living with HIV globally on antiretroviral therapy in 2018 is almost double the number on treatment in 2010. However, it is far short of the 2018target of 1.6 million.

Women and adolescent girls

Although large disparities still exist between young women and young men, with young women 60% more likely to become infected with HIV than young men of the same age, there has been success in reducing new HIV infections among young women. Globally, new HIVinfections among young women (aged 15–24 years) were reduced by 25% between 2010 and 2018, compared to a 10% reduction among older women (aged 25 years and older). But it remains unacceptable that every week 6200 adolescent girls and young women become infectedwith HIV. Sexual and reproductive health and rights programmes for young women need to be expanded and scaled up in order to reach more high-incidence locations and maximize impact.

HIV prevention

Communities at the centre shows that the full range of options available to prevent new HIV infections are not being used for optimal impact. For example, pre-exposure prophylaxis (PrEP), medicine to prevent HIV, was only being used by an estimated300 000 people in 2018, 130 000 of whom were in the United States of America. In Kenya, one of the first countries in sub-Saharan Africa to roll out PrEP as a national programme in the public sector, around 30 000 people accessed the preventative medicinesin 2018.

The report shows that although harm reduction is a clear solution for people who inject drugs, change has been slow. People who inject drugs accounted for 41% of new HIV infections in eastern Europe and central Asia and 27% of new HIV infections in the MiddleEast and North Africa, both regions that are lacking adequate harm reduction programmes.

Men remain hard to reach. Viral suppression among men living with HIV aged 25–34 years is very low, less than 40% in some high-burden countries with recent surveys, which is contributing to slow progress in stopping new HIV infections among their partners.

Stigma and discrimination

Gains have been made against HIV-related stigma and discrimination in many countries but discriminatory attitudes towards people living with HIV remain extremely high. There is an urgency to tackle the underlying structural drivers of inequalities and barriersto HIV prevention and treatment, especially with regard to harmful social norms and laws, stigma and discrimination and gender-based violence.

Criminal laws, aggressive law enforcement, harassment and violence continue to push key populations to the margins of society and deny them access to basic health and social services. Discriminatory attitudes towards people living with HIV remain extremelyhigh in far too many countries. Across 26 countries, more than half of respondents expressed discriminatory attitudes towards people living with HIV.

Communities

The report highlights how communities are central to ending AIDS. Across all sectors of the AIDS response, community empowerment and ownership has resulted in a greater uptake of HIV prevention and treatment services, a reduction in stigma and discriminationand the protection of human rights. However, insufficient funding for community-led responses and negative policy environments impede these successes reaching full scale and generating maximum impact.

In KwaZulu-Natal in South Africa, one in four adults (aged 15–59 years) were living with HIV in 2016. To advance the response, Médecins Sans Frontières managed a community-based approach to HIV testing that links people to treatment and supports them to remainin care. By 2018, the 90–90–90 targets were achieved in Eshowe town, rural Eshowe and Mbongolwane, well ahead of the 2020 deadline.

Another study in South Africa and Zambia enrolled hundreds of Community HIV Care Providers (CHIPS) over five years to visit homes, provide information about HIV and offer HIV testing and linkage to care. The study found that areas with CHIPS communities hadaround 20% fewer new HIV infections each year and the proportion of people living with HIV who knew their HIV status, were on antiretroviral therapy and were virally suppressed increased from 54% to more than 70%.

UNAIDS urges countries to live up to the commitment made in the 2016 United Nations Political Declaration on Ending AIDS for community-led service delivery to be expanded to cover at least 30% of all service delivery by 2030. Adequate investments must be madein building the capacity of civil society organizations to deliver non-discriminatory, human rights-based, people-centred HIV prevention and treatment services in the communities most affected by HIV.

In 2018, an estimated:
•37.9 million [32.7 million–44.0 million] people globally were living with HIV
•23.3 million [20.5 million–24.3 million] people were accessing antiretroviral therapy
•1.7 million [1.4 million–2.3 million] people became newly infected with HIV
•770 000 [570 000–1.1 million] people died from AIDS-related illnesses








UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP,UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.















Jul. 9, 2019











Listen to Drs. David E. Griffith and Theodore K. Marras explore treatment options for a complex NTM case, including the importance of adhering to NTM treatment guidelines (and why most clinicians are not!) CME & MOC available!

Difficult to Treat Mycobacterium Avium Complex Lung Disease


Additional Education Available Here!




Jul. 9, 2019

 

Jul. 9, 2019

New essential medicines and diagnostics lists published today

WHO updates global guidance on medicines and diagnostic tests to address health challenges, prioritize highly effective therapeutics, and improve affordable access

 


WHO’s Essential Medicines List and List of Essential Diagnostics are core guidance documents that help countries prioritize critical health products that should be widely available and affordable throughout health systems.

 

Published today, the two lists focus on cancer and other global health challenges, with an emphasis on effective solutions, smart prioritization, and optimal access for patients.

“Around the world, more than 150 countries use WHO’s Essential Medicines List to guide decisions about which medicines represent the best value for money, based on evidence and health impact,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The inclusion in this list of some of the newest and most advanced cancer drugs is a strong statement that everyone deserves access to these life-saving medicines, not just those who can afford them.”

The Essential Medicines List (2019)

Cancer treatments: While several new cancer treatments have been marketed in recent years, only a few deliver sufficient therapeutic benefits to be considered essential. The five cancer therapies WHO added to the new Medicines List are regarded as the best in terms of survival rates to treat melanoma, lung, blood and prostate cancers.

For example, two recently developed immunotherapies (nivolumab and pembrolizumab) have delivered up to 50% survival rates for advanced melanoma, a cancer that until recently was incurable.

Antibiotics: The Essential Medicines Committee strengthened advice on antibiotic use by updating the AWARE categories, which indicate which antibiotics to use for the most common and serious infections to achieve better treatment outcomes and reduce the risk of antimicrobial resistance.  The committee recommended that three new antibiotics for the treatment of multi-drug resistant infections be added as essential. 

Other updates to the medicines list include:

  • New oral anticoagulants to prevent stroke as an alternative to warfarin for atrial fibrillation and treatment of deep vein thrombosis. These are particularly advantageous for low-income countries as, unlike warfarin, they do not require regular monitoring;
  • Biologics and their respective biosimilars for chronic inflammatory conditions such as rheumatoid arthritis and inflammatory bowel diseases;
  • Heat-stable carbetocin for the prevention of postpartum haemorrhage. This new formulation has similar effects to oxytocin, the current standard therapy, but offers advantages for tropical countries as it does not require refrigeration;

Not all submissions to the EML Committee are included in the list. For example, medicines for multiple sclerosis submitted for inclusion were not listed. The Committee noted that some relevant therapeutic options currently marketed in many countries were not included in the submissions; it will welcome a revised application with all relevant available options. The EML Committee also did not recommend including methylphenidate, a medicine for attention deficit hyperactivity disorder (ADHD), as the committee found uncertainties in the estimates of benefit.

The List of Essential (in vitro) Diagnostics

The first List of Essential Diagnostics was published in 2018, concentrating on a limited number of priority diseases – HIV, malaria, tuberculosis, and hepatitis. This year’s list has expanded to include more noncommunicable and communicable diseases.

Cancers: Given how critical it is to secure an early cancer diagnosis (70% of cancer deaths occur in low- and middle-income countries largely because most patients are diagnosed too late), WHO added 12 tests to the Diagnostics List to detect a wide range of solid tumours such as colorectal, liver, cervical, prostate, breast and germ cell cancers, as well as leukemia and lymphomas. To support appropriate cancer diagnosis, a new section covering anatomical pathology testing was added; this service must be made available in specialized laboratories.

Infectious diseases: The list focuses on additional infectious diseases prevalent in low- and middle-income countries such as cholera, and neglected diseases like leishmaniasis, schistosomiasis, dengue, and zika.

In addition, a new section for influenza testing was added for community health settings where no laboratories are available.

General test: The list was also expanded to include additional general tests which address a range of different diseases and conditions, such as iron tests (for anemia), and tests to diagnose thyroid malfunction and sickle cell (an inherited form of anemia very widely present in Sub-Saharan Africa).    

Another notable update is a new section specific to tests intended for screening of blood donations.  This is part of a WHO-wide strategy to make blood transfusions safer.

“The List of Essential Diagnostics was introduced in 2018 to guide the supply of tests and improve treatment outcomes,” said Mariângela Simão, WHO Assistant Director-General for Medicines and Health Products. “As countries move towards universal health coverage and medicines become more available, it will be crucial to have the right diagnostic tools to ensure appropriate treatment.”

The updated Essential Medicines List adds 28 medicines for adults and 23 for children and specifies new uses for 26 already-listed products, bringing the total to 460 products deemed essential for addressing key public health needs.  While this figure may seem high, it corresponds to a fraction of the number of medicines available on the market.  By focusing the choices, WHO is emphasizing patient benefits and wise spending with a view to helping countries prioritize and achieve universal health coverage.  

The updated List of Essential Diagnostics contains 46 general tests that can be used for routine patient care as well as for the detection and diagnosis of a wide array of disease conditions, and 69 tests intended for the detection, diagnosis and monitoring of specific diseases.

The List is divided into two sections depending on the user and setting: one for community settings, which includes self-testing; and a second one for clinical laboratories, which can be general and specialized facilities.  

Both WHO lists are models for countries to develop their own national lists.  National lists based on local disease burden and existing healthcare delivery infrastructure provide an excellent framework from which countries can plan and implement the laboratory services and the medicines they need.  Access to these health products requires good procurement practices, effective supply chains, quality management protocols and qualified health care workforces. The delivery of effective diagnostic services, because they are based on technologies, also depends on robust technical specifications, the availability of carefully designed laboratory networks, adequate supporting infrastructure and appropriate education of users (patient or health worker) to ensure safety.

Jul. 3, 2019
Jul. 1, 2019

30. Health is a prerequisite for sustainable and inclusive economic growth. We recall our commitment to
moving towards achieving universal health coverage according to national contexts and priorities. We look
forward to the United Nations General Assembly High Level Meeting on Universal Health Coverage (UHC).
Primary health care including access to medicines, vaccination, nutrition, water and sanitation, health
promotion and disease prevention is a cornerstone for advancing health and inclusion. We will strengthen
health systems with a focus on quality including through enhancing health workforce and human resources
for policy development and promoting public and private sector innovation, such as cost-effective and
appropriate digital and other innovative technologies. Recognizing the importance of sustainable financing
for health, we will call for greater collaboration between health and finance authorities in accordance with
9
the G20 Shared Understanding on the Importance of UHC Financing in Developing Countries, to which our
commitment was affirmed by our Finance and Health Ministers at their Joint Session. We encourage
international organizations and all stakeholders to collaborate effectively and we look forward to the
upcoming presentation of the global action plan for healthy lives and well-being for all.
31. We will promote healthy and active ageing through policy measures to address health promotion,
prevention and control of communicable and non-communicable diseases, and through people-centered,
multi-sectoral, community-based integrated health and long-term care over the life course in accordance
with national context including demographic trends. We will implement comprehensive set of policies to
address dementia, including promoting risk reduction and sustainable provision of long-term care as well as
inclusive societies aiming to improve quality of lives of people with dementia and caregivers.
32. We are committed to improving public health preparedness and response including strengthening our
own core capacities and supporting capacities of other countries in compliance with the World Health
Organization (WHO) International Health Regulations (2005). We will support countries suffering from the
current Ebola outbreak in Africa, through both timely financial and technical assistance and in line with the
central coordination responsibility that WHO has for international responses to health emergencies. We will
work for the sustainability and efficiency of global health emergency financing mechanisms. We reaffirm our
commitment to eradicate polio as well as to end the epidemics of AIDS, tuberculosis and malaria and look
forward to the success of the sixth replenishment of the Global Fund to fight AIDS, Tuberculosis, and Malaria.
33. We will accelerate efforts based on the One-Health approach to tackle antimicrobial resistance (AMR).
Recognizing the UN Secretary-General’sreport on AMR, which was informed by the recommendations of the
UN Interagency Coordination Group on AMR and other relevant initiatives, we encourage all stakeholders
including international organizations to act and coordinate on those items relevant to their missions that
contribute to global efforts to combat AMR. We recognize the need for policy measures for infection
prevention and reduction of excessive antimicrobial usage. Further action should be taken to promote
stewardship of and access to antimicrobials. Noting the ongoing work done by Global AMR R&D Hub, we will
promote R&D to tackle AMR. We call on interested G20 members and Global AMR R&D Hub to analyze push
and pull mechanisms to identify best models for AMR R&D and to report back to relevant G20 Ministers.