PAHO calls for new generation of HIV treatment programmes in the Americas

The Caribbean has the highest rates of antiretroviral treatment (ART) coverage of any developing region in the world, with an estimated 63 percent of people with HIV who need treatment receiving it, according to Pan American Health Organization/World Health Organization (PAHO/WHO) 2012 report.
But a new report from the organisation says that preserving the region’s leadership in providing ART will require overcoming health system problems that range from drug stock-outs to lack of cost-effectiveness in the use of drug combinations.
The report, “Antiretroviral treatment in the spotlight: a public health analysis in Latin America and the Caribbean (LAC)”, analyzes the vulnerabilities of ART programmes in LAC, and makes recommendations for strengthening countries’ health systems to ensure the sustainability of those programmes and continued progress toward universal access to ART.
“We are proud to see that the LAC region has staged an unprecedented response to HIV, with leading rates of ART coverage available free of charge through all national programmes,” PAHO Director Dr. Mirta Roses Periago writes in the report’s preface. With this new study, “PAHO is engaging Member States, civil society, and technical partners to move from the baseline described in this report through a series of programmatic steps that, supported by the provision of quality technical cooperation, will define the implementation of a new generation of HIV treatment programmes in the Americas.”
The report analyzes data on ART prices, procurement and consumption patterns; HIV-tuberculosis co-infections; and dependence on external financing, among other variables. It concludes that the majority of patients receiving ART in LAC are taking effective and safe antiretrovirals (ARVs).
However, the report highlights a number of challenges in ensuring effectiveness and efficiency in the use of ARVs. A small percentage of patients—five percent of those on first-line therapy and 14 percent on second-line therapy—are taking inappropriate combinations, according to the study.
A more generalized problem is inefficiency: the median number of first-line ARV regimes in each LAC country is 12, and the median number of second-line regimens is 15, in both cases more than twice the WHO recommendation of six different regimens per treatment line. Compounding this problem is the fact that many countries are paying higher prices for ARVs than necessary, due to shortcomings in procurement practices.
It was further noted that by the end of 2010, 521,000 people in LAC were receiving ART, representing, on average, 63 percent of those who need such treatment.
Only 11 of 36 countries in LAC report a high dependency on external financing for ART. These countries account for approximately 20 percent of persons living with HIV.
In 2011, more than half of LAC countries (14 out of 26 countries, or 54 percent) reported at least one stock-out episode. Main causes include bidding, procurement and distribution problems and complications in ARV production.