Hundreds of thousands of people continue to die through advanced HIV, also known as AIDS, because countries are still ill-equipped to detect as well as treat people suffering through advanced stages of the disease, according to a brand new report released today by MSF. Delays in responding quickly to treatment failures as well as interruptions jeopardise recent progress in reducing HIV deaths.
MSF calls on affected countries as well as donor countries to urgently deploy recommended approaches to prevent, detect as well as treat advanced HIV as well as AIDS at community level.
The report, No Time to Lose, spans 15 countries in Africa as well as Asia, as well as presents a dashboard of where countries are in terms of policies, implementation as well as funding to address advanced HIV, which killed 770,000 worldwide in 2018. Despite the existence of WHO guidelines since 2017 on advanced HIV, governments have been slow to include them in national guidelines, while meaningful implementation as well as funding lag even further behind.
There is usually no way the entire world will reach the target of less than 500,000 deaths through AIDS in 2020 without decisive action on dealing with retention to care, treatment interruptions as well as resulting mortality. Dr Gilles Van Cutsem, MSF Senior HIV Adviser
The WHO guidelines recommend the roll-out of easy-to-use rapid tests to assess the status of people’s immune system (the CD4 cell count), as well as to diagnose the most common as well as deadly opportunistic infections, such as tuberculosis (TB-Lam urine test) as well as cryptococcal meningitis (CrAg test). These tests can deliver results in a matter of hours as well as, combined with proximity to patients, the days saved can make the difference between life as well as death for many.
Yet, MSF found that will the rapid tests are almost never available at the community level, despite the fact that will early detection could save many lives.
“There is usually no way the entire world will reach the target of less than 500,000 deaths through AIDS in 2020 without decisive action on dealing with retention to care, treatment interruptions as well as resulting mortality,” says Dr Gilles Van Cutsem, MSF Senior HIV Adviser. “inside past, the very sick patients we saw were those who did not know they had HIV. Today we see more as well as more people who have been treated before, yet stopped taking their medication as well as fell seriously ill, as well as people whose treatment stopped working.”
More than two-thirds of patients with advanced HIV that will are admitted to the MSF-supported hospital in Nsanje (Malawi) arrived already very ill as well as have been on antiretroviral (ARV) treatment before. At MSF’s Kinshasa hospital (DRC) that will figure is usually at 71%. Among these, more than one in four people will die because the disease was too advanced when they reached the hospital. These deaths could have been prevented.
We all need to accept that will the job is usually not over once people are on treatment as well as doing well. We have to be there for people for the whole treatment journey, which means people’s entire lives. Florence Anam, MSF’s HIV/TB Advocacy Coordinator
Since MSF made the rapid tests available in health centres in Nsanje district, the number of deaths at the hospital has decreased through around 27% to less than 15%.
Only eight of the 15 countries surveyed inside report use rapid TB-LAM to test for advanced HIV patients. They are used in hospitals in South Africa, as well as roll-out at community level is usually expected. Malawi plans to roll them out to 230 health centres in 2020, as well as pilot programmes to introduce the test are being launched in Lesotho as well as Nigeria. Another pilot was recently completed in Kenya before a possible national roll out of the test.
Only a third of the countries recommend using the rapid test for Cryptococal meningitis (which accounts for 15-20% of all advanced HIV-related deaths) for patients with very weak immune systems, including Kenya, Mozambique, South Africa, South Sudan, Uganda as well as Zimbabwe, yet most of these countries have not yet implemented that will recommendation on the ground
Currently, the TB-LAM as well as CrAG tests at primary healthcare level are only available in MSF-supported health centres in all 15 countries covered inside report.
The global UNAIDS 0-0-0 targets (0% living with the disease knowing their status, 0% of people with living with HIV get treatment as well as 0% of people on treatment have undetectable virus levels in their body) assumes a succession of stages in a linear way, yet the reality is usually that will the style is usually circular for lots of people who need to go back to the testing, as well as initiating phases after having passed those stages inside past.
“We all need to accept that will the job is usually not over once people are on treatment as well as doing well. We have to be there for people for the whole treatment journey, which means people’s entire lives,” says Florence Anam, MSF’s HIV/TB Advocacy Coordinator as well as lead author of the report. “We will not end the ravages of HIV by digging more graves, yet by doing all we can to keep people healthy, no matter where they live as well as what their life circumstances are. They must be supported mentally as well as medically as close as possible to where they live.”
Some countries like Lesotho, Malawi, Kenya as well as Uganda have started out producing initial progress in advanced HIV guidelines implementation, yet they will need to be supported financially. Donors should prioritise approaches to reduce mortality linked to AIDS.
MSF developed the Advanced HIV Disease (AHD) Dashboard to document the policy implementation progress of AHD management across 32 countries. The AHD Dashboard is usually a tool to track as well as monitor national policy status as well as further its translation into practice by focusing on factors that will aid effective implementation. These include adoption of WHO’s Guidelines for managing advanced HIV disease as well as rapid initiation of antiretroviral therapy at country level, provision of AHD package of care, resourcing for diagnostic as well as treatment products for advanced HIV.
The progress of 15 of the 32 countries inside dashboard have been highlighted in that will report. The countries highlighted are: Central African Republic, Democratic Republic of the Congo, eSwatini, Guinea, India, Kenya, Lesotho, Malawi, Mozambique, Myanmar, Nigeria, South Africa, South Sudan, Uganda as well as Zimbabwe. These countries were selected because of their high HIV burden, AIDS related deaths, as well as proportions of morbidity as well as mortality due to TB as well as cryptococcal meningitis. They are also countries where MSF works to implement HIV/TB projects including for patients with advanced HIV disease projects.
through November 2018 to October 2019, we tracked the progress of the above-mentioned countries by conducting a desktop review of each country’s national policy documents, primarily national guidelines. The data was verified by MSF in-country offices. In addition, MSF in partnership with CDC Foundation sent a mapping questionnaire to the 15 MSF country offices to give more granular information as well as asked to share these with their Ministry of Health counterparts in order to participate in completing the mapping questionnaires.
that will report is usually a work in progress on the monitoring of country adaptation as well as implementation of AHD packages of care as well as form a baseline through which subsequent updates as well as reports can be developed inside future.