UNAIDS wants to treat 90% of people with HIV by 2020. But laboratories around the world are facing shortages and cannot meet the needs.
To end the HIV epidemic, UNAIDS has set an ambitious target for 2020. The United Nations HIV program wants to detect 90% of people living with HIV, treat 90% with antiretrovirals and achieve viral load suppression in 90% of them.
Ambitious, of course, but it may not be achieved. World Health Organization (WHO) expert group sounds the alarm in PLOS Medicine. Laboratory tools are underutilized and some countries lack the capacity to achieve these goals.
37 million people living with HIV
This work is based on the analysis of annual surveys sent to WHO offices in 127 member countries. The responses delivered between 2012 and 2014 were scrutinized by Vincent Habiyambere’s team. These surveys make it possible to assess the capacity of each State to detect children, monitor the evolution of lymphocytes attacked by HIV and the virus load in the body.
The documents are far from reassuring, at a time when 37 million people are living with HIV. Most countries do not have the capacity to monitor the viral load of people with HIV. Reactive agents, key elements in the context of biological examinations, are the first victims of the lack of supply.
Even when the infrastructure and equipment are sufficient, their use is far from optimal. Less than 14% of CD4 + lymphocyte analysis devices are used and 36.5% of viral load monitoring tools are used. It is precisely these examinations that make it possible to evaluate the effectiveness of a treatment.
Necessary governance
The laboratories are therefore not able to meet the needs of the population. The progress made during the three years of analysis will not make up for the delay. Under these conditions, it is difficult to achieve the 90-90-90 UNAIDS target, the study authors conclude. They recognize that the private sector is not included in this analysis, which can make a difference. But they take up a double challenge: “We must assess the root causes of this under-use of instruments and resolve them. These corrections call for resolution in order to achieve the targets of UNAIDS.
Some measures fall under national adjustments, ensuring sufficient equipment, strengthening access to healthcare, for example. Most of the problems brought to light by the WHO team can be corrected with sufficient organization. “The international community should focus on the optimal use of laboratory technologies in countries where upgrading interventions are most needed,” say the authors. In an associated article, Peter Kilmarx (American Institutes of Health) and Ravia Sambi (Zimbabwe’s Ministry of Health and Children) evoke a wide range of concrete challenges that stand in the way of an effective and accessible system for all. The lack of governance is the main obstacle with planning.
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