PHA-Exchange> Treating 3 million by 2005 - Making it happen

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WHO AND UNAIDS UNVEIL PLAN TO GET 3 MILLION AIDS PATIENTS ON TREATMENT
BY 2005

Simple Treatment Regimens Published
Training Tens of Thousands of People to Support AIDS Treatment and
Prevention


1 December 2003, GENEVA

The World Health Organization (WHO) and UNAIDS today release a detailed
and
concrete plan to reach the 3 by 5 target of providing antiretroviral
treatment to three million people living with AIDS in developing
countries
and those in transition by the end of 2005. This is a vital step
towards the
ultimate goal of providing universal access to AIDS treatment to all
those
who need it.

UNAIDS announced last week that 40 million people around the world are
infected with HIV, and that the global AIDS epidemic shows no signs of
abating. Five million people became infected with HIV worldwide and 3
million died this year alone - that's 8,000 people every day. WHO
estimates
that six million people worldwide are in immediate need of AIDS
treatment.
This strategy outlines the steps needed to deliver treatment to half of
them
within two years.
The strategy is a key element in a combined programme of accelerating
HIV/AIDS prevention and treatment. Much has already been done by
countries,
by UNAIDS, the World Bank, foundations, WHO and many other groups.
After
twenty years of fighting the epidemic, it is now clear that a
comprehensive
approach to HIV/AIDS must include prevention, treatment and care.

Evidence and experience shows that rapidly increasing the availability
of
antiretroviral treatment in line with 3 by 5 targets can lead to more
people
knowing their HIV status and more openness about AIDS. Individuals on
effective treatment are also likely to be less infectious and less able
to
spread the virus. Good treatment programmes will make more people come
forward for testing HIV/AIDS status. Treatment can therefore contribute
to
the rapid acceleration of prevention.

Building on work done by UNAIDS, developing and donor countries, NGOs
and
other multilateral agencies, WHO and UNAIDS are taking another big step
forward in the global movement to increase access to prevention and
treatment services.


3 by 5 Strategy

To reach the 3 by 5 target, WHO and UNAIDS will focus on five critical
areas:
- Simplified, standardised tools to deliver antiretroviral therapy
- A new service to ensure an effective, reliable supply of medicines
and
diagnostics
- Rapid identification, dissemination and application of new knowledge
and
successful strategies
- Urgent, sustained support for countries
- Global leadership, strong partnership and advocacy


Simplified Treatment Recommended

The strategy has greatly simplified the recommendations for AIDS
treatment
regimens. The number of such WHO-recommended regimens has been cut to
four
from 35. All four are equally effective. The selection of an individual
regimen for a patient will be based on a combination of individual
needs,
together with the availability and suitability of a particular regimen
in a
country. The strategy also recommends the use of quality-assured "fixed
dose
combinations" or easy-to-use blister packs of medicine whenever they
are
available. The aim is to ensure that all people living with AIDS, even
in
the poorest settings, have access to treatment through this simplified
approach.

The strategy also includes the global AIDS Medicines and Diagnostics
Service
(AMDS), which will ensure that poor countries have access to quality
medicines and diagnostic tools at the best prices. The service, which
will
be operated by WHO, UNICEF and other partners, will help countries to
forecast and manage supply and delivery of necessary products for the
treatment and monitoring of AIDS. Through the WHO Prequalification
Project,
AMDS will also include a medicines and diagnostics evaluation component
which will ensure that manufacturers, products, procurement agencies
and
laboratories meet international quality, safety and efficacy standards.

Another key element is the simplification of monitoring, so that
easy-to-use
tests such as body weight and colour-scale blood tests are used where
more
complicated and expensive tests for viral load and white cell (CD4)
count
are not yet available. The simpler tests, combined with clinical
evaluations
by adequately trained health workers, can be effective in monitoring
the
progress of AIDS, the effectiveness of treatment and its side effects.


Treatment Action in Countries Already Under Way

Antiretroviral therapy programmes can only be expanded if there is
coordinated, scaled-up action in countries, particularly those
hardest-hit
by AIDS. Countries are at the heart of the 3 by 5 strategy and will be
the
focus of all efforts to meet the 3 by 5 target. Many countries have
already
demonstrated their commitment to this target. Immediately following the
declaration of a global AIDS treatment emergency, more than 20
countries
requested collaboration and input from WHO, UNAIDS and other partners.

Teams have already travelled to Kenya, Burkina Faso, Malawi and Zambia.
Other teams have done preparatory work in Ukraine and India. In each
case,
the teams will be working with governments to identify and help remove
obstacles, so that antiretroviral medicines can be provided quickly to
the
people who need them most. Many other countries, including Russia and
Djibouti, have also requested assistance.

Training of health workers is an urgent need in all countries involved.
Many
of the countries with the highest numbers of people living with
HIV/AIDS
have very few doctors or other trained health staff. Many of these
health
workers have died as a result of untreated AIDS; others have moved to
seek
better pay and job security in wealthier countries.


Thousands of community workers to be trained

One of the most innovative aspects of the 3 by 5 strategy is a method
for
urgently training tens of thousands of community health workers to
support
the delivery and monitoring of HIV/AIDS treatment. An intensive
training
programme would enable these health workers to evaluate and monitor
patients, and make sure they receive and are taking their medicines.
The strategy acknowledges that the involvement of communities and
community
workers is essential to the success of this initiative. Significant
evidence
and experience shows that without strong community support, people may
have
a more difficult time adhering to their medical regimens. Also,
community
involvement is a critical element of any successful HIV prevention
strategy.

One of the key elements of the strategy is "learning by doing". The
strategy
unveiled today by WHO and UNAIDS addresses many of the obstacles that
have
up to now prevented millions of people in poor countries from accessing
AIDS
medicines. The strategy will evolve as lessons learnt from implementing
the
strategy are identified and rapidly applied.


Funding

Reaching the 3 by 5 target will require substantial new funding for
AIDS
treatment from all sources - countries, donor governments and
multilateral
funding agencies. WHO has estimated that the funding required amounts
to
approximately $5.5 billion over the next two years.

For more information contact:

Mr Iain Simpson
Email: simpsoni at who.int
Ms Melanie Zipperer
Email: zippererm at who.int