传染病学英文版课件：final

TakingthePulse:GlobalUpdateontheHealthSectorResponsetoHIV,2014DrGundoWeilerCoordinatorStrategicInformationHIVDepartmentWorldHealthOrganizationWHOSatelliteatAIDS2014,20July2014GlobalHealthSectorStrategyonHIV/AIDS2011-2015-anewhealthsectoragendaforHIV/AIDSLeveragebroaderhealthoutcomesthroughHIV/AIDSresponsesReducevulnerabilitiesandremovestructuralaccessbarriersBuildstrongandsustainablehealthsystemsOptimizeHIVprevention,diagnosis,treatmentandcare❷❸❶❹GaugingrecentprogressintheglobalHIVresponse2.1millionHIVinfections ▼15% 240000HIVinfectionsinchildren ▼40%1.5millionHIVrelateddeaths ▼25%320000TB-relateddeathsinPLWHA*

▼36%**

*2012 **2004-2012[1.9–2.5million][1.4–1.7million][210000–280000][300000–340000]2013 2009-2013Outline01|Prevention,diagnosis,treatmentandcareARTPMTCTPrevention02|Serviceintegration03|Systemsstrengthening04|RemovingstructuralbarriersMethodologyGlobalAIDSResponseProgressReporting(GARPR)Annualreportingofprogrammedatabycountries(MoH,NAPs),electronicplatformmanagedbyUNAIDS,validatedjointlybyWHO,UNICEF,UNAIDSByJune2014,131outof144low-andmiddleincomecountriesprovidedARTdata,representing99%ofestimatedtotalnumberofpeopleonARTatendof2013CountrypoliciesandpracticesReal-timetrackingofimplementationofHIVhealthsectorpoliciesinpracticesin58focuscountries,includingUBRAFhighimpactcountriesandGlobalPlancountriesCountrysubmissionthroughGARPRandvalidation/completionbyWHOin-countrystaff.12,9millionpeopleonARTattheendof2013globally.11,7inlow-andmiddleincomecountries-2millionmorethanattheendof2012Actualandprojectednumbersofpeoplereceivingantiretroviraltherapyinlow-andmiddle-incomecountries,andbyWHORegion,2003–2015Source:2014GlobalAIDSResponseProgressReporting(WHO/UNICEF/UNAIDS).CatalyseHIVtreatment,careandsupportAfrica,withmostpeoplelivingwithHIV,continuestodriveglobalscale-up,butlow-coverageRegionsarecatchingupCatalyseHIVtreatment,careandsupportTotal:11.7millioninLMIC36%78800044%910000037%2800010%25400022%40200032%110000033%Source:2014GlobalAIDSResponseProgressMonitoring(WHO/UNICEF/UNAIDS)andUNAIDS/WHO/UNICEFestimatesGlobalscale-updrivenbylargeincreasesinARTforadultsAdults9,0m10,9m+21%>1in3adultswithHIVonART(37%)CatalyseHIVtreatment,careandsupportSource:2014GlobalAIDSResponseProgressMonitoring(WHO/UNICEF/UNAIDS)andUNAIDS/WHO/UNICEFestimatesThegapbetweenaccesstoARTforchildrenandadultscontinuestowidenAdultsChildren9,0m740k10,9m640k+21%+15%1in4childrenwithHIVonART(23%)CatalyseHIVtreatment,careandsupport>1in3adultswithHIVonART(37%)Source:2014GlobalAIDSResponseProgressMonitoring(WHO/UNICEF/UNAIDS)andUNAIDS/WHO/UNICEFestimatesHIVhasbecomethe2ndbiggestcauseofdeathforadolescentsgloballyCatalyseHIVtreatment,careandsupportSource:Healthoftheworld’sadolescent,WHO2014AccesstoARTforpeoplewhoinjectdrugsremainsinsufficient,theexampleofEasternEuropePWIDamongallPLWHAPWIDamongallonARTPeoplewhoinjectdrugsasaproportionofallpeoplelivingwithHIVwithaknowntransmissionrouteandTheproportionofpeoplewhoinjectdrugsWhoreceivedantiretroviraltherapyinreportingcountries,WHOEuropeanRegionCatalyseHIVtreatment,careandsupportOutline01|Prevention,diagnosis,treatmentandcareARTPMTCTPrevention02|Serviceintegration03|Systemsstrengthening04|Removingstructuralbarriers05|LookingaheadCloseto1millionpregnantwomenreceivedARVs,500,000stillbeingmissedEliminatenewHIVinfectionsinchildrenSource:2014GlobalAIDSResponseProgressMonitoring(WHO/UNICEF/UNAIDS)andUNAIDS/WHO/UNICEFestimatesSource:GlobalAIDSResponseProgressReporting(WHO/UNICEF/UNAIDS)and2013UNAIDSestimates.ReachingtheglobaltargetwilldependonprogressinsomehighburdencountrieswithpersistinglowcoverageEliminatenewHIVinfectionsinchildrenTanzaniaDRoftheCongoEliminatenewHIVinfectionsinchildrenSteadyincreaseinroll-outofEarlyInfantDiagnosis,butstilltoofewexposedchildrentestedPooledcoverageofEIDin88countrieswithdatafrom2011and2013Source:2014GlobalAIDSResponseProgressMonitoring(WHO/UNICEF/UNAIDS)Outline01|Prevention,diagnosis,treatmentandcareARTPMTCTPrevention02|Serviceintegration03|Systemsstrengthening04|Removingstructuralbarriers05|LookingaheadKeypopulationsaredisproportionallyaffectedbyHIV,anddisturbingnewsonoutbreaksacrossallregionsAverageHIVprevalenceinkeypopulationsurveysandgeneralpopulationInvigorateHIVPreventionSource:Unpublishedliteraturereviewbasedon88countrystudies,2007-2013SexworkerMenwhohavesexwithmenTransgenderpeoplePeoplewhoinjectdrugsButstillglaringgapsinaddressingtheneedsofkeypopulationsinnationalHIVplansPercentageof58WHOHIVFocalCountrieswithexplicitreferencetospecifickeypopulationsintheirnationalHIV/AIDSPlan,June2014InvigorateHIVPreventionInvigorateHIVPreventionVMMCincreasedby50%in2013toatotalof5.8million,butitsfullpotentialisfarfrombeingexhaustedOutline01|Prevention,diagnosis,treatmentandcareARTPMTCTPrevention02|Serviceintegration03|Systemsstrengthening04|Removingstructuralbarriers05|LookingaheadAcceleratingincreaseinARTcoverageamongnotifiedTBpatientsto70%PercentageofpeoplecoinfectedwithHIVandnotifiedTBwhoinitiatedART,2007–2013ServiceIntegrationSource:provisionaldatafromtheGlobalTuberculosisProgrammeDatabase,June201485%ofallANCattendeesweretestedforsyphilis-countriesaretargetingdualeliminationServiceIntegrationPercentageofantenatalcareattendeestestedforsyphilisatfirstvisit,2012Source:2014GlobalAIDSResponseProgressMonitoring(WHO/UNICEF/UNAIDS)HIVissupportinganemerginghepatitisagendaServiceIntegrationShareamong58WHOHIVfocuscountriesofferinghepatitisservicesinARTclinics,June2014Source:WHOHIVCountryIntelligenceDatabase,June2014Outline01|Prevention,diagnosis,treatmentandcareARTPMTCTPrevention02|Serviceintegration03|Systemsstrengthening04|Removingstructuralbarriers05|LookingaheadPricescontinuetodecrease,butstockoutsremainofconcernMedianpricesofWHO-preferredfirst-lineregimensperpersonperyear,inUSdollars,inlow-andmiddle-incomecountries,2004–2013SystemsIntegrationInmultiplecountrieslaws,regulationsorpoliciesexistthatcanhinderserviceprovisionforkeypopulationsHumanRightsandAccessBarriersMSMSexworkersPWIDSource:GARPR2013–“Countriesreportingexistenceoflaws,regulationsorpoliciesthatcanposeobstaclestoeffectiveHIVprevention,treatment,careandsupportservicesforkeypopulations”Outline01|Prevention,diagnosis,treatmentandcareARTPMTCTPrevention02|Serviceintegration03|Systemsstrengthening04|Removingstructuralbarriers05|LookingaheadRapiduptakeof2013ARVguidelinesincreaseseligibilityPercentageof58WHOHIVFocalCountrieswithconfirmedadoptionofselectWHO2013ARVrecommendations,June2014_*or75%of22EMTCTGlobalPlancountries*Source:WHOHIVCountryIntelligenceDatabase,June2014EndingtheAIDSepidemicby2030Source:UNAIDSestimates(2014),GapreportChild–adultcoveragegapiswideningRapiduptakeofnewguidance,innovationisdrivingcountryresponsesNeweligibilitycriteriacallfornewambitioustreatmenttargetsConclusions:Mainfiguresandmessages12.9milliononARTglobally,record2millionincreasein2013740000childrenonART,only15%morethanin201240-50%ofcountrieshaveadopted2013ARVguidelinesHIVresponseblazesthetrailforuniversalhealthcoverageConsolidationaroundintegrated[HIV]servicepackages

FailureinreachingkeypopulationsSince2009,25%dropinmortality,butonly15%dropinincidenceAcknowledgementsCountries:MinistriesofHealthandNationalAIDSProgrammesfrom181countriesWHO:AndrewBall,TxemaCalleja,MichelBeusen