Seventy-three countries have warned that they are at risk of running out of antiretroviral drugs (ARVs) as a result of the COVID-19 pandemic, according to a new WHO survey conducted before the biennial conference of the International AIDS Society. Twenty-four countries reported having a critically low stock of ARVs or interruptions in the supply of these life-saving drugs.
The survey follows a modeling exercise convened by WHO and UNAIDS in May that predicted that a six-month disruption in access to ARVs could lead to a doubling of AIDS-related deaths in sub-Saharan Africa in 2020 alone.
In 2019, an estimated 8.3 million people benefited from ARVs in the 24 countries now experiencing supply shortages. This represents approximately one third (33%) of all people receiving HIV treatment globally. While there is no cure for HIV, ARVs can control the virus and prevent sexual transmission to others.
The failure of providers to deliver ARVs on time and the closure of ground and air transportation services, along with limited access to health services within countries as a result of the pandemic, were some of the causes cited by interruptions in the survey.
The results of this survey are deeply troubling, ”said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “Countries and their development partners must do everything possible to ensure that people in need of HIV treatment continue to access it. We cannot allow the COVID-19 pandemic to undo the hard-earned gains in the global response to this disease.
Stagnant progress
According to data released today by UNAIDS and the WHO, new HIV infections fell 39% between 2000 and 2019. HIV-related deaths fell 51% during the same time period, and some 15 million people were saved. lives through the use of antiretroviral therapy.
However, progress towards global goals is stagnating. In the past two years, the annual number of new HIV infections has stagnated at 1.7 million and there was only a modest reduction in HIV-related death, from 730,000 in 2018 to 690,000 in 2019. Despite the Ongoing progress in expanding treatment coverage – with more than 25 million people in need of ARVs to receive them in 2019 – will miss the key global targets for 2020.
HIV prevention and testing services do not reach the groups that need them most. Improved targeting of proven prevention and testing services will be critical to revitalizing the global response to HIV.
WHO guidance and action in the country
COVID-19 runs the risk of exacerbating the situation. WHO recently developed a guide for countries on how to safely maintain access to essential health services during the pandemic, including for all people living with or affected by HIV. The guide encourages countries to limit interruptions in access to HIV treatment through “multi-month dispensing,” a policy whereby drugs are prescribed for longer periods of time, up to six months. To date, 129 countries have adopted this policy.
Countries are also mitigating the impact of disruptions by working to maintain flights and supply chains, involving communities in the delivery of HIV drugs, and working with manufacturers to overcome logistical challenges.
New opportunities to treat HIV in young children
At the IAS conference, WHO will highlight how global progress in reducing HIV-related deaths can be accelerated by intensifying support and services for populations disproportionately affected by the epidemic, including young children. In 2019, an estimated 95,000 HIV-related deaths and 150,000 new infections among children. Only about half (53%) of the children who needed antiretroviral therapy received it. Lack of optimal medications with appropriate pediatric formulations has been a long-standing barrier to improving health outcomes for children living with HIV.
Last month, WHO welcomed the decision of the United States Food and Drug Administration to approve a new formulation of 5 mg dolutegravir (DTG) for infants and children over 4 weeks of age and weighing more than 3 kg . This decision will ensure that all children have quick access to an optimal medication that, to date, has only been available to adults, adolescents and older children. The WHO is committed to speeding up the prequalification of DTG as a generic drug so that countries can use it as soon as possible to save lives.
Through multi-partner collaboration, we are likely to see generic versions of dolutegravir for children in early 2021, allowing for a rapid reduction in the cost of this drug, “said Dr. Meg Doherty, Director of the HIV Department , Hepatitis and Global HIV STI Programs at WHO “This will give us another new tool to reach children living with HIV and keep them alive and healthy.”
Dealing with opportunistic infections
Many HIV-related deaths are the result of infections that take advantage of an individual’s weakened immune system. These include bacterial infections like tuberculosis, viral infections like hepatitis and COVID-19, parasitic infections like toxoplasmosis, and fungal infections, including histoplasmosis.
Today, the WHO publishes new guidelines for the diagnosis and management of histoplasmosis among people living with HIV. Histoplasmosis is highly prevalent in the WHO Region of the Americas, where up to 15,600 new cases and 4,500 deaths are reported each year among people living with HIV. Many of these deaths could be prevented by timely diagnosis and treatment of the disease.
In recent years, the development of highly sensitive diagnostic tests has allowed rapid and accurate confirmation of histoplasmosis and earlier initiation of treatment. However, innovative diagnoses and optimal treatments for this disease are not yet widely available in settings with limited resources.
