Access to HIV drugs is severely disrupted by Covid-19 and the AIDS response is no longer progressing. Countries are looking for innovative ways to mitigate the impact and ensure continuity of services.
People living with HIV face enormous constraints in their treatment. They face a breakdown of antiretrovirals (ARVs). According to a new World Health Organization (WHO) survey, 73 countries have reported that they are at risk of stockouts of antiretrovirals. This, due to the Covid-19 pandemic. Twenty-four countries reported that their ARV stock was extremely low or that the supply of these vital medicines was disrupted. This survey, conducted before the conference of the International Aids Society, follows a modeling carried out by the WHO in May.
According to the latter, a six-month interruption in access to ARVs could double the number of AIDS-related deaths in sub-Saharan Africa, in 2020 alone.
It is estimated that in 2019, 8.3 million people were receiving ARVs in the 24 countries that are currently experiencing shortages. This represents approximately one third (33%) of people taking HIV treatment worldwide. Although there is no cure for the disease, ARVs help control the virus and prevent its sexual transmission. The investigation revealed that the inability of suppliers to deliver ARVs on time and the closure of land and air transport services was the cause of the disturbances noted. These elements, combined with limited access to health services inside countries, due to the pandemic, make the situation of patients more difficult.
“The conclusions of this survey are very worrying,” analyzes the Director-General of WHO, Dr Tedros Adhanom Ghebreyesus. In his opinion, countries and partners working for development should do everything in their power so that those who need HIV treatment continue to have access to it. “We cannot let the Covid-19 pandemic negate the hard-fought advances in the global response to this disease.” he adds.
According to data released yesterday by the WHO, the number of new HIV infections decreased by 39% between 2000 and 2019. The number of deaths fell by 51% during the same period and antiretroviral treatment saved some 15 million lives. However, progress towards the global goals has stalled. Despite the constant efforts to scale up treatment coverage, more than 25 million people in need of ARVs received it in 2019. But the main global targets for 2020 will not be met. Because the survey reveals that the categories that need it most do not benefit from HIV infection prevention and screening services.
Therefore, better targeting of proven prevention and testing services will be essential to relaunch the global response to HIV.
Also, depending on the results of the investigation, the Covid-19 may worsen the situation. WHO has recently developed guidance for countries on how to safely provide access to essential health services during the pandemic. These guidelines encourage countries to limit disruptions in access to treatment for the disease, by delivering treatments for several months. They have established a prescription policy for drugs over a long period of time. To date, 129 countries have adopted it. Countries are also mitigating the impact of disruptions by maintaining flights and supply chains, engaging communities in the delivery of HIV drugs, and working with laboratories to overcome logistical challenges.
New ways to treat HIV infection in children
At the International Aids Society conference, WHO will show that it is possible to reduce the number of HIV-related deaths worldwide faster. To this end, it will recommend strengthening support and services for populations disproportionately affected by the epidemic, including young children. In 2019, it is estimated that there were 95,000 HIV-related deaths and 150,000 new infections in children. Only about half (53%) of the children who needed antiretroviral therapy received it. The lack of appropriate pediatric formulations for optimal drugs has long been a barrier to achieving better results for children living with HIV.
Last month, WHO welcomed the decision of the Food and Drug Administration of the United States of America which approved a new formulation of dolutegravir 5 mg for infants and children over 4 weeks and weighing more than 3 kg. This decision will allow them to quickly have access to an optimal medication which, today, is only available for adults, adolescents and older children. WHO is committed to accelerating the prequalification of dolutegravir as a generic medicine so that it can be used by countries as soon as possible to save lives.
“Thanks to the collaboration of several partners, generic versions of dolutegravir will probably be available for children by the beginning of 2021. This will make it possible to quickly lower the cost of this drug. This will give us a new tool to treat children living with HIV so they can stay alive and healthy, ” says Dr Meg Doherty, Director, Department of Global Programs for HIV, Hepatitis and Sexually Transmitted Infections, WHO .
Many HIV-related deaths are also due to infections resulting from the 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, WHO is publishing new guidelines for the diagnosis and management of histoplasmosis in people living with HIV. This disease is widespread in the WHO region of the Americas. Each year, there are up to 15,600 new cases, including 4,500 fatal, in people living with HIV. Early diagnosis and treatment of the disease would prevent many of these deaths.
In recent years, the development of very sensitive diagnostic tests has made it possible to quickly and precisely confirm cases of histoplasmosis and to initiate treatment earlier. However, innovative diagnostic tools and optimal treatments for this disease are not yet widely available in countries with limited resources.