WHO: Meeting Global Goals for HIV, Hepatitis, STIs Requires Accelerated Effort

More action is needed to meet goals to eliminate HIV, viral hepatitis, and sexually transmitted infections by 2030, according to a recently released World Health Organization (WHO) progress report.

The report is a midterm look at progress WHO member states have made toward implementing strategies to guide actions from 2016-2021 aimed at eliminating the diseases by 2030. The report notes that HIV infections are declining, but not rapidly enough; global targets for reducing mortality from viral hepatitis B and C will require accelerating universal access to testing and treatment; and STIs are not declining globally and are increasing in some countries.

Jason Schafer, PharmD, associate professor of pharmacy practice at Thomas Jefferson University in Philadelphia and the HIV section editor for the Contagion^® print publication, emphasized the “sheer number of individuals impacted, the lives that are at risk, and those that could be saved if the targets are met.”

The 3 diseases highlighted in the report cause 2.8 million deaths each year, according to the WHO. Meeting targets could save 1.7 million lives and prevent 1.2 million people from developing cancer each year.

“Working across disease programs may have the greatest impact,” Schafer told Contagion^®. “The report identifies several opportunities for integrating efforts to reduce all three diseases simultaneously.”

Bringing all diseases under a universal health coverage data platform and scaling up point-of-care and self-testing for the diseases were among the most significant steps necessary to accelerate progress, Schafer said.

“People may think that the targets are unattainable,” Schafer said. “However, they can be achieved with the WHO’s strategic direction:

• Improving health information systems to inform policies and program implementation for sustainable impact.
• Delivering high-impact interventions for HIV, viral hepatitis and sexually transmitted infections at high coverage, to retain people and to leave no one behind.
• Deliver services that are available to everyone regardless of their circumstances and with adequate quality.
• Providing universal health coverage to ensure that everyone can receive the services they need without incurring financial hardship.
• Investing in research and innovation to overcome barriers and enhance the efficiency, quality and impact of interventions.”

The report highlights opportunities to fill gaps to reach targets. For example, new antiviral medicine available since 2013 demonstrated >90% cure rates, but reaching the target would require an estimated $6 billion a year in incremental funding compared with spending of about half a billion dollars in 2016.

The report also outlines a 5-year window to accelerate progress toward universal health coverage.

“They did make the call for funding, which I think is really important, and I think it’s an essential piece,” Carl W. Dieffenbach, PhD, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, told Contagion^®. “The focus on universal health care…as a broad stroke, a broad approach to deal with disease in general, I think, is laudable.”

Challenges to meeting global health care goals include a recent shift toward nationalist perspectives and a lack of authority on the part of organizations such as WHO to develop policy, Dieffenbach said, describing the report as “a call for governments to step up and take care of their people.”

Dieffenbach said the Undetectable Equals Untransmittable (U=U) movement is worth consideration but wasn’t included in the report. Although many investigators continue to seek a cure for HIV, the U=U campaign is working to break down the stigma associated with HIV as those infected with the virus experience increased wellbeing.

“Getting people fully suppressed for 6 months really changes the sense of self-stigma in people when they really understand what U=U can give them. It’s something that WHO should consider,” Dieffenbach said. “If you create the vision that through the delivery of antiretroviral therapy you can take a community where there’s death and dying and reinstate a sense of health and wellbeing that can become an economic engine, I think even a minister of finance would buy that one.”

Dieffenbach also pointed out the significance of TB. A recent study in Latin America found that people diagnosed with both HIV and TB were twice as likely to die within 10 years as those who did not have TB.

“TB is the single greatest source of morbidity and mortality in the HIV population,” Dieffenbach said. “Whether or not it deserved to be a fourth pillar, we can debate. But to me if we’re going to go to the trouble of linking these three disease states, we really ought to be adding TB into the mix from the beginning and not just as an afterthought.”