World AIDS Day 2020 – WHO calls for global solidarity to sustain HIV services

WHO calls on 1 December for global leaders and citizens to come together for “global solidarity” to sustain key HIV services during COVID 19 and beyond – and to ensure the continued provision of HIV services to children, adolescents and the most vulnerable populations for this disease. The organization also calls on states to provide health workers with greater protection and support so they can continue their work safely during a pandemic.

Protecting people from HIV during a pandemic and ensuring that they can sustain treatment is crucial. Researchers are currently investigating whether people with HIV have an increased risk of poor outcomes with COVID-19. A preliminary analysis of hospitalized individuals with COVID-19 from 21 countries was reported WHO Global COVID-19 clinical data platform Notes that among 61 414 people hospitalized with suspected or confirmed COVID-19 infection, 5 291 (8.6%) have HIV positive status which has been found to increase the risk of death when adjusted for disease severity, age, sex and comorbidity burden; the absolute risk for all in the analysis was low.

This preliminary evidence of moderately increased vulnerability of people with HIV makes it even more urgent for people with HIV to have access to antiretroviral drugs (ARVs) and drugs for similar diseases – such as non-communicable diseases (NCDs), chronic obstructive pulmonary disease (COPD), diabetes and tuberculosis.

The WHO and partners sounded the alarm earlier this year, concerned about the impact of reported disruptions in service delivery. But now, thanks to the tireless work of health and community workers, the number of countries reporting disruptions in the provision of HIV services has dropped by almost 75% since June. Only 9 of the 152 countries surveyed still report interference (maps: June 2020 – November 2020); and in June, 24 countries reported less than 3 months of ARV supply, while now only 12 report critically low inventories.

This is mainly due to the application of existing guidelines, including the provision of multi-month issuance (MMD) of ARVs over 3-6 months to patients who have not had access to health facilities; strong WHO-led global, regional, national, manufacturing, and partnership coordination to ensure an adequate supply of drug supplies and the continued provision of basic health services and community-based delivery mechanisms.

But countries have also introduced a number of effective adjustments and innovations in service delivery during COVID-19. That includes:

• In many countries of sub-Saharan Africa, testing for COVID-19 relied heavily on laboratory systems built and developed by HIV and TB programs. The devices are shared among the programs, as are the infrastructure, sample transportation systems, and highly qualified staff.
• In Thailand, PrEP services are provided through key population-led health services, providing multi-month issuance, telehealth, Xpress service, self-sampling and counseling.
• In Bulgaria, a demonstration project demonstrated strong community demand for HIV self-testing, which also led to the expansion of testing services to reduce inequalities between rural and urban areas.

“On World AIDS Day 2020, we pay tribute to communities and countries that have shown resilience and innovation – and are often led by people living with HIV themselves,” says Dr. Meg Doherty, Director of Global HIV Programs. a, hepatitis and STIs. “This is vital, because as we focus on fighting this new pandemic, we must not dismiss the twin pandemic that has been with us for 40 years and that is not over yet.”

Progress towards global goals for diagnosis and treatment has slowed this year.

New data shows that approximately 26.0 million people were on antiretroviral treatment in mid-2020, which is only 2.4% compared to an estimate of 25.4 million at the end of 2019. This increase is too slow compared to last year in which treatment coverage increased by an estimate of 4.8% between January and June 2019. Among the 24 countries with monthly data reported to UNAIDS and WHO, people currently in treatment were supported and maintained, but testing dropped overall, and newly enrolled in treatment halved. In the last few months; however, there are positive signs of recovery testing and treatment services.

The WHO hopes that some of the innovative approaches adopted during COVID-19 can help the world catch up and accelerate progress towards our new 2025 goals and the SDG goals to stop AIDS as a threat to public health by 2030.