WHO hopes 3-by-5 plan will reverse Africa's HIV/AIDS epidemic

Abstract

WHO together with UNAIDS, unveiled plans on 1 December, World AIDS Day, to get urgently-needed treatment to millions of AIDS patients in developing countries, as the global HIV/AIDS pandemic hit grim new highs according to a recent UNAIDS/ WHO report. The AIDS Epidemic Update 2003, released on 25 November, said that 40 million people--5 million of whom were infected in 2003--were living with HIV/AIDS. It said that over two-thirds of the world's HIV/AIDS cases were in southern Africa but that now the virus was spreading fastest in eastern Europe and central Asia, where the number of cases tripled between 1999 and 2002. WHO's plan to get antiretroviral (ARV) treatment to 3 million people by 2005, known as the initiative, is seen as a vital step to providing universal treatment for AIDS patients across the world. Antiretroviral therapy was hailed in the 1990s as a triumph of modern science. Experts and the media proclaimed ... the defeat of AIDS.... Sadly, that optimism was misplaced, WHO Director General, Dr LEE Jongwook, told high-profile guests at the 3-by-5 launch in Livingstone, Zambia. LEE said that WHO's initiative had been made possible by the current political and financial attention being paid to AIDS by multilateral institutions such as the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria, coupled with US President George Bush's pledge to donate US$ 15 billion to AIDS treatment and other pledges from groups like the Bill and Melinda Gates Foundation. All of this has been further complemented by the efforts of pharmaceutical companies to reduce the prices of patented AIDS drugs. LEE said the initiative had in part been inspired by groundbreaking work by nongovernmental organizations such as Medecins Sans Frontieres and that its success would depend on national and international agencies and critically, the courageous contributions of national governments, especially in Africa, to increasing their people's access to ARV-based AIDS care. Under the new WHO plan, about 100 000 new paramedics and nurses in developing countries will be trained to provide simplified treatment and prescribe newly-WHO-approved fixed-dose combination drugs to AIDS patients. The single pills--which have recently been added to the list of medicines meeting WHO standards--contain three drugs: lamivudine, stavudine and nevirapine which temporarily suppress viral replication and improve symptoms. Two of those fixed-dose triple combination drugs are produced by Indian generic drugs company Ranbaxy and the third, by India's Cipla. Fixed-dose drugs have proved successful in treating malaria and tuberculosis. Whether in the form of a single pill or a blister pack containing three pills, such triple combinations are cheaper to deliver, provide medication that is easier for patients to follow than three separate pills and can be prescribed by medical staff who are not qualified doctors. The WHO Prequalification Project--part of the strategy--aims to assess the quality, safety and clinical efficacy of HIV medicines distributed in developing and transition countries. Currently the Prequalification list contains over 50 stogie-drug, two-drug and three-drug combinations, including the three newly-qualified products. The Prequalification Project is a core element of the new AIDS, Medicines and Diagnostics Service (AMDS), a new mechanism created to make sure that the supply of safe, effective and affordable medicines of good quality are more easily accessible. UNAIDS Executive Director, Dr Peter Plot, said he hoped that once ARV treatment was widely available in the developing world more people would come forward to be tested and that this would help raise awareness of the disease and stem the spread of the deadly virus. …