Presentation –Action plan for the health sector response to HIV
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Dr Nedret Emiroglu, Director, Health Emergencies and Communicable Diseases
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Presentation –Action plan for the health sector response to HIV
- 1. Action plan for the health sector response to HIV Dr Nedret Emiroglu Director Health Emergencies and Communicable Diseases
- 2. HIV is decreasing globally but increasing in Europe – and remains concentrated in key populations Estimated new infections (global) and newly diagnosed infections (regional) 20000 40000 60000 80000 100000 120000 140000 160000 1400000 1600000 1800000 2000000 2200000 2400000 2600000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Global WHO European Region Eastern part of Region Western and central parts of Region Sources: ECDC/WHO HIV/AIDS surveillance in Europe 2014; and UNAIDS/WHO global HIV estimates. 2 Global: left scale Regional: right scale
- 3. Number of people receiving ART and AIDS rates, 2005-2015 Antiretroviral therapy (ART) coverage remains inadequate in eastern Europe and AIDS is increasing Estimated % of people living with HIV on ART (2015): • EECA: 21% • Global: 46% 0.0 2.0 4.0 6.0 8.0 10.0 12.0 0 200000 400000 600000 800000 1000000 1200000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 AIDScasesper100000population ART - Western and central Europe (left scale) ART - Eastern Europe and central Asia (EECA) (left scale) AIDS rate - EECA (right scale) AIDS rate - Region (right scale)
- 4. Elimination of mother-to-child transmission of HIV and syphilis • Three European countries successfully validated elimination: – Armenia: HIV – Belarus: HIV and syphilis – Republic of Moldova: syphilis • Many more countries are preparing for validation 4 Photos: UNAIDS
- 5. Alignment with global and regional policies and strategies New HIV action plan calling for urgent accelerated response Action plan development: • Building on lessons learned • Broad Region-wide participatory process 5
- 6. Action plan for the health sector response to HIV • Zero new HIV infections, zero HIV-related deaths and zero HIV-related discrimination in a world where people living with HIV are able to live long and healthy lives 2030 Vision • To end the AIDS epidemic as a public health threat by 2030, within the context of ensuring healthy lives and promoting well-being for all at all ages 2030 Goal Frameworks for action: universal health coverage, the continuum of services, a public health approach 6
- 7. Strategic direction 1: Information for focused action (the “who” and “where”) Fast-track actions Know your epidemic and response Use data to guide focused HIV services and investments along the HIV cascade of services Set national targets and milestones, update national strategies Link HIV strategic information systems with broader health information systems Strengthen the HIV response through strong coordination across stakeholders and involvement of civil society 7
- 8. Strategic direction 2: Interventions for impact (the “what”) Fast-track actions Define an essential package of interventions for inclusion in the national health benefit package Prioritize interventions for key and vulnerable populations Adopt a “treat all” approach to maximize the prevention benefits of ART Expand HIV testing approaches to reach those who are unaware of their infection Eliminate HIV in infants 8
- 9. Strategic direction 3: Delivering for equity (the “how”) Fast-track actions Implement an essential package of services based on equity and human rights principles Implement differentiated care packages for people living with HIV (PLHIV), based on care needs Ensure integrated, people-centred and community-based care Create an enabling policy and legal environment 9
- 10. Strategic direction 4: Financing for sustainability (the financing) Fast-track actions Finance a sustainable HIV response to achieve the 90-90-90 targets Monitor health expenditures to reduce cost of drugs and services, remove health-related financial risk for PLHIV Strengthen procurement and supply management Transit from external to domestic HIV financing 10
- 11. Strategic direction 5: Innovation for acceleration (the future) Fast-track actions Stimulate innovation of technologies, service delivery and models of collaboration Encourage HIV service delivery through innovative approaches that are designed and delivered in collaboration with civil society Ensure a particular focus on reducing the undiagnosed proportion of PLHIV and innovative service delivery for key populations 11
- 12. Draft resolution – EUR/RC66/Conf.Doc./5 Rev.1 • Review and revise national HIV strategies and targets, prioritizing key populations • Strengthen HIV prevention by promoting evidence-based interventions; implement an essential package of services • Reinforce political commitment and ensure sustainable financing • Continue working in partnerships to strengthen the HIV response, and facilitate the exchange of best practices • Monitor and report to 69th and 72nd Regional Committees on implementation of the action plan 12
Notas do Editor
- Today we are presenting a new action plan on HIV in Europe for your consideration. The WHO European Region is at a critical point with regard to HIV. While new HIV infections are decreasing globally, in Europe they are increasing. New HIV diagnoses have increased by 76% since 2005 in the Region as a whole and have more than doubled in the east. Not only are new infections increasing. The epidemic remains concentrated in key populations, mainly among men who have sex with men (MSM) in the centre and west and among people who inject drugs in the East. If time permits, consider: Transmission through injecting drug use is declining in most countries, but still accounts for almost half of all new HIV cases with a known transmission mode in the East where MSM related transmission is underreported and stigmatized.
- Good news is that more people are receiving antiretroviral therapy (ART) in the Region. The overall number on ART increased from 360 000 in 2005 to about one million in 2015 and almost tripled in the East during the last five years (from 112 100 in 2010 to 321 800 in 2015). However, in the eastern part of the Region, only an estimated 21% of all people living with HV were receiving treatment in 2015 – well below the global average of 46%. (If time permits: Please note here that newly revised WHO treatment guidelines, that recommend ART to all people living with HIV, has lowered the ART coverage compared with past recommendations where only people with more advanced disease would be eligible for treatment.) The number of new AIDS diagnoses continue to increase in the eastern part of the Region. This is the result of several factors: About half of people continue to be diagnosed at a late stage of infection (48% had a CD4 cell count below 350 cells/mm3 at the time of diagnosis in 2014) In some countries, up to half of people living with HIV are unaware of their infection. Delayed initiation of ART and low treatment coverage. FYI/additional: The percentage of people diagnosed late was largest in the eastern part of the Region and smallest in the western part. This is partly explained by the larger numbers of people who inject drugs with HIV in the East who tend to be diagnosed later than people from other transmission groups. Against this epidemiological situation, we need an urgent and accelerated fast track response to curb the epidemic in the Region.
- Another area in which the Region has made excellent progress is towards eliminating mother to child transmission of HIV and congenital syphilis as a public health threat. Three European countries - Armenia, Belarus and Moldova - were provided with elimination certificates at the High Level Meeting on HIV in New York in June this year. I know many others are working with us towards validating elimination.
- We conclude that the HIV epidemic in the European Region is moving faster than the current programmes established to address it, and that a fast track response is required. The new HIV Action plan advocates for an urgent and accelerated health sector response to HIV and builds on lessons learned from the previous European Action Plan that ended in 2015. The goals and targets in the plan are supported by the 2030 Agenda for Sustainable Development, the 2016-2021 multisectoral UNAIDS Strategy, the WHOs Global health sector strategy on HIV for 2016–2021, and Health 2020, the European policy framework for health and well-being. The Action plan was developed through a broad Region-wide participatory process including a Regional technical consultation convened in June 2015 and drawing on the expertise of an advisory committee that met in Copenhagen in April 2016. It also sought feedback through direct correspondence with Member States, major partners and people living with HIV, and through a broader public web consultation on the action plan.
- The Action plan is built around three organizing frameworks for action: universal health coverage; the continuum of HIV services; and the promotion of a public health approach in accordance with the Global Health Sector Strategy for HIV 2016-21. Our vision for 2030 is a WHO European Region with zero new HIV infections, zero HIV-related deaths and zero HIV-related discrimination in a world where people living with HIV are able to live long and healthy lives. Our goal for 2030 is to end the AIDS epidemic as a public health threat in the European Region in the context of ensuring healthy lives and promoting well-being for all at all ages. Key targets for 2020, contributing towards achieving the 2030 goal proposed in this new action plan focus on: Strengthening prevention efforts (reducing new infections by 75% or an appropriate numerical target for low-prevalence countries) Scaling up testing and treatment – the global 90-90-90 targets (90% of people living with HIV know their HIV status; 90% of people diagnosed with HIV receive ART; 90% of people living with HIV on ART achieve viral load suppression) Reduction of AIDS related deaths Eliminating discrimination Ensuring financial sustainability
- The action plan is organized around five strategic directions, each with a set of fast track actions for Member States, WHO and partners. The next five slides summarize these fast track actions which are described in more detail on pages 7 through 14 in the RC document EUR/RC66/9. Strategic direction 1 focuses on the need to generate and use quality strategic information about the HIV epidemic. Strategic information forms the basis for focused national strategic planning and programme implementation, and advocacy to garner political commitment. It guides Member States to evaluate the health systems’s performance along the HIV continuum of care and develop targeted high-impact programmes and interventions.
- Strategic direction 2 describes the delivery of critical, high-impact evidence-based interventions to optimize the continuum of HIV services, including prevention, testing, treatment and care. This strategic direction encourages countries to specify an essential package of interventions for inclusion in the national health benefit package for people living with HIV or at risk of acquiring HIV. It focuses on the implementation of interventions contextualized to the local epidemiology and setting, prioritizing interventions aimed at key populations who are disproportionately affected by HIV to ensure that no one is left behind.
- Strategic direction 3 responds to the need for an enabling environment and optimization of service delivery. It focuses on identifying the best approaches for delivering services by promoting integrated, people-centered services and ensuring equity and quality. It also focuses on the involvement of civil society, including people living with HIV, in the design and delivery of interventions. If time permits: This strategic direction also draws on the years of evidence that shows that HIV interventions are most effective when they occur in enabling social, legal, policy and institutional environments.
- Strategic direction 4 urges Member States to develop sustainable and innovative models to finance their HIV response. This activity is critical as the European Region is facing the withdrawal of funding from international donors. This demands the Region identify domestic resources and efficiency-focused strategies which enable the continued delivery of HIV services in a way that minimises service interruptions and minimises out of pocket expenses for PLHIV.
- Strategic direction 5 identifies those areas where there are major gaps in knowledge and technologies. It highlights the areas where innovation is required to shift the course of the HIV epidemic to achieve the 2020 targets and 2030 goal and vision. Given of much of the HIV-related need in the Region is situated among key and vulnerable populations, Member States focus should be on innovations targeted at these populations. Accordingly, innovation in the WHO European Region should look to biomedical advancements as well as innovations in communication, behaviour change, service delivery, economic modelling, and engagement strategies for key and vulnerable populations.
- The draft Resolution request Regional Committee consider a resolution to adopt the Action plan and urge Member States to: review and revise national HIV strategies and targets based on the local epidemiology and national context, prioritize key populations, women and girls, to ensure full access to HIV prevention, testing and treatment services and to remove legislative and structural barriers through intersectoral collaboration and involvement of civil society; strengthen HIV prevention by promoting high-impact, evidence-based cost-effective comprehensive interventions and innovative tools; define a package of services for people living with HIV and ensure implementation of a set of interventions, by promoting integrated, people-centred and community-based services to meet treatment coverage targets; reinforce political commitment and ensure sustainable financing for HIV. The draft resolution also requests the Regional Director to: support the implementation of the Action plan through leadership, strategic direction and technical guidance to Member States; continue work in partnership to advocate for commitment and resources to strengthen the response to HIV; facilitate the exchange of best practices and evidence-informed tools for an effective HIV response; monitor implementation and report to the 69th and 72nd sessions of the Regional Committee on the implementation of the Action plan in the WHO European Region.