WHO unveils plans to treat 3 million by 2005

Keith Alcorn
Published: 01 December 2003

The World Health Organisation has published details of its plan to bring antiretroviral treatment to 3 million people living with HIV by the end of 2005.

The `3 x 5` initiative is the most ambitious public health venture ever attempted. Once they begin treatment, the 3 million people with HIV recruited in the first two years of the programme will form the vanguard of a massive, ongoing programme that is likely to embrace tens of millions of people within a decade.

At yesterday’s press conference in Geneva, WHO was stressing the urgent nature of the problem rather than the long-term challenge, which could re-cast national health care systems and the attitudes of wealthy nations towards solving problems in the developing world.

"It is unacceptable for 8,000 people to die every day from a preventable and treatable disease," Dr Charles Gilks of WHO said yesterday.

In a nutshell, WHO wants severely affected countries to start providing a fixed dose antiretroviral regimen to all people with HIV who have symptoms (including TB). Treatment will consist of either AZT/3TC or d4T/3TC plus nevirapine or efavirenz, and it will be delivered and monitored by health care workers and clinical officers, as well as community volunteers.

WHO also announced that it has pre-qualified three generic fixed dose combinations containing d4T, 3TC and nevirapine.

WHO is aiming to turn around attitudes towards HIV testing by arguing for `the right to know`, hoping to leverage prevention gains from promoting the notion that access to treatment is a human right, obtained through HIV testing.

Core elements of the WHO plan and the challenges facing WHO and partners

1. Develop global leadership, alliances and advocacy

  • Advocate for funding, together with UNAIDS and other partners, raising money for drugs, training and strengthening country health services.
    • WHO says that even with the cheapest drug prices, the cost of implementing 3 x 5 will reach $4.9-5.5 billion by the end of 2005. Only 35% of that cost comprises antiretrovirals.
    • WHO itself will need an extra $350 million by the end of 2005 to reach its 3 x 5 targets

  • Commit hundreds of personnel at the country level to the 3 by 5.
    • WHO plans to redeploy 200 staff to WHO country offices by June 2004 to support scale-up efforts, and a total of 480 will have been redeployed by December 2005.

  • Publish, with UNAIDS, ethical guidelines promoting equity and human rights in ART.
    • WHO is concerned that the roll-out of treatment could bypass the poorest members of society and marginalised social groups. Guidelines will place pressure on governments to ensure that treatment is equitably distributed.

2. Provide urgent, sustained country support

  • Provide emergency response teams for high burden countries, as requested by the country, to assess need and help define 3 by 5 targets.
    • WHO teams have already visited Kenya, Burkina Faso, Malawi and Zambia
    • 20 countries have already expressed interest (click here for details). WHO aims to engage with 50 countries by the end of 2004.

  • Encourage national political commitment for 3 by 5.
    • WHO aims to work with at least 35 countries to draw up implementation plans for antiretroviral therapy by June 2004, and 60 countries by the end of 2005.
    • WHO will support advocacy efforts directed at forcing national governments to face up to the enormity of the crisis.

  • Work with national governments to strengthen health systems to respond to the crisis.
  • Start the emergency expansion of training with a goal to train 100,000 professional and lay staff by the end of 2005.
  • WHO has published a summary of its training plans. Click here to download the document.

  • Strengthen physical resources like laboratories and testing equipment.

3. Simplify standardised tools and assure quality

  • Establish uniform standards and simplified tools to track ART.
    • WHO proposes a number of core indicators to help monitor national programmes and allow comparison between countries (click here for full details). These include number of health personnel trained per 1,000 people in need of treatment, perectage of districts with at least one centre providing ARVs to national standards, percentage of people with advanced HIV infection receiving ART according to national guidelines, number of drug regimens distributed to patients per month, 12 month programme retention rate, percentage of adults experiencing weight gain of at least 10% within first six months of treatment, percentage of people alive after 6, 12, 24 months of treatment.

  • Identify multiple entry points for treatment, including TB and reproductive health programs, NGO’s, faith-based organizations and other potential providers of antiretroviral therapy.

    • Click here to download a WHO factsheet in pdf format on entry points to antiretroviral treatment
    • 30,000 community-based organisations should be drawn into partnership with publicly-funded ARV facilities by the end of 2005.
    • 20,000 outlets for HIV treatment and voluntary counselling and testing should be established by the end of 2005.
    • WHO will encourage the establishment of community advisory commitees, and will provide financial support for the development of advocacy and community capacity-building to support ARV treatment

  • Simplify treatment regimes and guidelines for antiretroviral therapy.

4. Create an effective, reliable supply of medicines and diagnostics

  • Establish an AIDS Medicines and Diagnostics Service to assist countries to secure uninterrupted access to appropriately priced, quality, antiretrovirals and diagnostics.
    • Click here to download a WHO factsheet on the AIDS Medicines and Diagnostics Service
    • WHO aims to support drug procurement in 50 countries by the end of 2005 through this service.

  • Disseminate information on legal and regulatory issues, prices and sources.
  • Develop and distribute technical tools for supply and demand forecasting, procurement, quantification, and supply-chain management.
  • Continue the pre-qualification of manufacturers and products.
  • Assist buyers to obtain best prices for individual or pooled demand.
    • WHO is assuming that the `best price` for a triple combination will still lie in the region of $400 in 2004 and will have fallen to $250 by the end of 2005. Medecins sans Frontieres says: "WHO's drug price targets lack ambition and do not reflect prices that are currently available."

  • Arrange for targeted technical and operational support to countries.

5. Rapidly identifying and reapplying new knowledge and successes

  • Establish global communication systems to share progress and experience.
  • Document early successes and share them with all partners.
  • Develop and carry-out an appropriate operational research agenda.
  • Build a situation room to track progress towards 3 by 5 Milestones .

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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