Prevention and Treatment Scale-up - 3 by 5 and TB: Issues and Challenges

1. Prevention and Treatment Scale-up - 3 by 5 and TB: Issues and Challenges Two diseases – One patient Prof Charlie Gilks Director and Coordinator Treatment Prevention Scale-up (TPS), HIV/AIDS Department, WHO Geneva 4th Global TB-HIV Working group meeting Addis Ababa, Ethiopia 21-21st September 2004

2. A shared global target to provide antiretroviral therapy to 3 million people with HIV/AIDS by the end of 2005, with the goal of achieving universal access 15% of treatment burden is in children Equal numbers of men and women TB a major "entry point" for ART What is "3 by 5"?

3. To transform HIV/AIDS from a death sentence to a chronic disease management problem like diabetes: strengthen the health system and change health service utilisation patterns To accelerate HIV prevention and reduce over the long-term the burden of treatment need which otherwise can never be addressed nor can ART programmes ever be sustainable The ultimate challenges for "3 by 5"

4. Treatment scale-up: countries that have requested assistance, March 04

5. Why? Specialist physician-led individual patient management approach with real time diagnostics is impossible globally: Uganda: 1 MD to 18,000 population; 120,000 in need of ART now Malawi: 1 microscope per 100,000 population; 1.2 lab techs per district Globally standardized and harmonised approaches Simplified treatment : first & second-line regimes; the 4S's Minimum data set, patient cards, drug cards, M&E indicators Commodity procurement and supply Integrated and not vertical implementation Decentralised, district-based approach Community engagement The Public Health Approach to ART

6. Training for scaling up ART

7. Target-driven Public health approach Integrate prevention with treatment Brand name Partnerships Standardisation and harmonisation Link patient to drug flow and many more …….. Huge influence of TB learnings

8. Integrated not vertical service delivery Burden of disease Impact on health-care delivery Multi-tasked health worker (burnout) Complexity of the intervention Chronic disease management Supply chain management Knowledge management systems Two diseases - one patient; one health system But we need to extend this model

9. Common philosophy and approach Comprehensive policy framework Well defined collaborative activities Collaborative mechanisms established Effective ways to reduce TB in HIV/AIDS Effective ways to reduce HIV in TB patients TB services starting point for ARTdelivery Progress & Synergy: TB & HIV

10. Re-examine the complex impact of HIV on TB control Presentation and diagnosis Case management Is DOTS effective in high-burden areas? As ART scales up, how to protect "core business" Entry points and exit points Accelerating disease prevention Addressing stigma Challenges & Issues: TB and HIV

11. One health system with multiple challenges Over-tasked multi-tasked health worker Human resources for health Integrated not parallel processes Learning by doing Concrete success stories Operational research agenda Challenges & Issues: TB and HIV

12. Stop TB and 3by5: a great common base Much remains to be done The devil is in the detail Two diseases – one patient Health system issues are/will be critical Accelerate prevention in all we do Conclusions

13. 65 weeks till end 2005 a sense of urgency ….