WHO launches guidelines to speed up delivery of antiretroviral drugs to HIV/AIDS patients



Experts from WHO's HIV/AIDS programme are developing a standardized set of guidelines to simplify and speed up the delivery of antiretroviral (ARV) medicines and treatment to HIV/AIDS patients all over the world.

The guidelines which are due to be unveiled on World AIDS Day on 1 December will be followed by a massive training programme to instruct thousands of nurses and other medical workers in the new procedure.

Both guidelines and training are part of a new WHO drive to address the failure to deliver ARVs to the millions of people who need them in the developing world. WHO declared this a global public health emergency on 22 September at the UN General Assembly High-Level Meeting on HIV/AIDS in New York.

"ARV [antiretroviral] treatment is still very tailored to individual patients which means that a huge number of ARV combinations are possible," said Gottfried Hirnschall from WHO's HIV/AIDS department, adding that this makes drug procurement and training unnecessarily complicated, timeconsuming and more costly.

The idea of a single standardized ARV procedure was inspired by WHO's recent success with DOTS, a standardized treatment strategy for people with tuberculosis. Standardization is one of a number of new initiatives launched in October to tackle the worsening global epidemic.

The Global Fund to fight AIDS, Tuberculosis and Malaria said that of the US$ 623 million in funds it has raised and approved for new grants, about 60 per cent would be channelled into HIV/AIDS programmes. Other agencies have joined WHO in their challenge to achieve the global "3 by 5" target of delivering ARV medicines to 3 million people by 2005. The World Food Programme (WFP), for example, has joined UNAIDS to boost the UN's response to the HIV/AIDS epidemic by working to deliver food supplies to people with HIV/AIDS in the developing world.

The Bill and Melinda Gates Foundation has responded by doubling its grant to fight AIDS in India to US$ 200 million, its largest single donation so far. According to UNAIDS, around 3.97 million adults in India were infected with HIV in 2001, and warned that the disease may become, within the next decade, the main cause of adult mortality in the world's second most populous country.

As with the SARS global alert, WHO has promised to send emergency response teams of experts, at the request of governments, to poor countries with a high HIV/AIDS prevalence.

So far WHO has received a number of queries and formal requests for help. A WHO emergency response team has already visited Nairobi, the Kenyan capital, and teams were due to leave for Burkina Faso, Malawi, and Zambia by the end of October.

"The teams will assess the current situation in the country, agree on the WHO's role there, help strengthen WHO's country teams and recruit additional technical experts," Dr Hirnschall said.

WHO wants to encourage countries with a high prevalence to set more ambitious targets for delivering ARVs. Brazil is the only developing country that delivers ARVs to 100 per cent of patients that need them.

WHO will also be pushing countries to raise their targets from 10 per cent in the next few years to the 50 per cent target set by WHO for 2005. This is believed to be a realistic goal because 50 per cent of people with HIV/AIDS have access to formal medical services.

Another major obstacle to getting the drugs to the people who need them is price. Despite heavy discounting by pharmaceutical firms and a recently agreed trade deal to let poor countries import cheap copies of patented drugs, ARVs may still be too expensive for many countries, especially those in sub-Saharan Africa. To address this, WHO wants to help negotiate bulk orders of a standardized ARV drug combination for groups of countries, or regions, to knock prices down even further.

Research published in a recent issue of the Lancet (Lancet 2003;9392:1267-74) which presented new evidence that ARV therapy is extremely effective has provided added backing to WHO in its push to achieve the "3 by 5" target.

World Health Organization Genebra - Genebra - Switzerland
E-mail: bulletin@who.int