WHO's '3 by 5' plan gains momentum

The second half of 2004 was a busy time for African governments as they cranked up the roll out of anti-AIDS drugs to their HIV-positive citizens. In sub-Saharan Africa the number of people on antiretroviral (ARV) treatment doubled in just six months with up to 310,000 people on medication by December 2004, and there are now well over 700 sites in the region that can deliver ARVs. The World Health Organisation (WHO) and UNAIDS on Wednesday released the second progress report on the '3 by 5' initiative - three million people in the developing world on ARV therapy by the end of 2005 - at the World Economic Forum meeting in Switzerland. According to the report, in Botswana, Kenya, South Africa, Uganda and Zambia the number of people on ARVs rose by more than 10,000 in each country; more than a quarter of all people who need treatment in Uganda, Namibia and Botswana are currently receiving it. Despite these inroads, overall coverage in sub-Saharan Africa was still low - just 8 percent, the report warned. Up to 5.1 million adults need treatment in 2005 - 72 percent of them in this region. "The figures speak for themselves - global progress towards the '3 by 5' target can only be made if major progress is made in the countries with the greatest unmet need for treatment," the organisations commented. Financial constraints remain a major hurdle, particularly the cost of ARV medicines to countries. The report estimated that to reach '3 by 5' would require about US $3.8 billion this year, but a study released by the international NGO, Action Aid, has warned that WHO is facing a $2 billion funding shortfall, which could knock off course its ability to meet its commitments. WHO and UNAIDS called for more people to come forward for testing and counselling, to improve access to treatment. But children had been "tragically neglected" and there were few programmes for treating them. Dr Eric Goemaere, head of Medecins Sans Frontieres (MSF) in South Africa, agreed: "It's a scandal that the majority of provinces [in the country] are hardly treating children." Treating them is difficult. Pharmaceutical companies have not yet developed fixed-dose combination treatments in dosages appropriate for children, and physicians often have to portion out a cocktail of three separate adult-dose medicines in different combinations as the child grows. To determine correct paediatric doses most effectively, caregivers should ideally use the three drugs according to the surface area of the child - a number obtained by a complicated formula of multiplying the child's weight by its length, dividing by 3,600, and then taking the square root of that number. The UN Children's Fund (UNICEF) and WHO have convened a meeting to plan the development of paediatric ARV formulations that will be simpler and more practical to use, said the report. While access to treatment was expanding, the lack of skilled healthcare workers presented another challenge - as many as 100,000 trained healthcare workers were needed to handle the growing national programmes, the study pointed out. Goemaere warned that centralised and hospital-based treatment programmes would not be sustainable. "If want this to last, and to have an impact on prevention, we need to make this as simple as possible, so that everybody can do it - not just doctors," he told PlusNews. People had to be treated at community level. "A lot of people are not able to come to a large hospital which is the central designated ARV site - the transportation fees, the distance ... in the long run, they will drop out." Zambia's rapidly expanding rollout was a case in point, HIV-positive activist Winston Zulu noted. "Even though the drugs are free, you still have to pay for all the tests that come with being on ARVs, and you still have to travel to get them." According to Zulu, it was "not just a question of numbers, we need to do it right." "Enrolling 2.3 million new people on ARV therapy [in 2005] is clearly the most difficult task the global public health community has ever faced. However, we should be encouraged by the rapid progress we have witnessed in the last six months," the report observed. Goemaere admitted that the target would be difficult to achieve, "but it's good to have an ambitious target. People are under pressure to move, and things are moving - and moving fast." To access the report: www.who.int