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Metrics for monitoring the cascade of HIV testing, care and treatment services in Asia and the Pacific.

November 16, 2016


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In Asia and the Pacific, an estimated 4.9 million people were living with HIV in 2012.  Although the rate of new HIV infections has decreased over the last decade, there are still an estimated 353 000 new infections each year in the region. HIV treatment services have been rapidly scaled up and as a result, the number of people receiving antiretroviral therapy (ART) has increased more than fourfold over the past five years, from 280 000 in  2006 to 1 250 000 by the end of 2012. Nevertheless, a substantial treatment gap remains −  only 51% of those eligible had access to ART in Asia and the Pacific in 2012.

Although the number of new infections is declining in the region, the number of people in need of treatment is expected to increase in coming years. Those who are already infected are progressing to later stages of the disease and those on ART are surviving longer. Recent research showing the prevention and treatment benefits of earlier initiation of ART has led to the expansion of eligibility criteria, further increasing the demand for ART services.

In response to these challenges, WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the Treatment 2.0 initiative in 2010. The principles and priorities of Treatment 2.0 are designed to achieve universal access to HIV care and treatment services and maximize the preventive benefits of ART by improving their  efficiency, coverage and impact.  In 2013, WHO released consolidated guidelines for a public health approach to the diagnosis, care and treatment of HIV infection. (5) The guidelines recommend earlier initiation of ART for adults and adolescents with a CD4 count of 500 cells/mm3 or less.

Triple-drug therapy is recommended for several populations regardless of CD4 count, including HIV-positive partners of serodiscordant couples, pregnant and breastfeeding women, children under five years of age, and persons with active tuberculosis (TB)  infection or severe chronic liver disease due to hepatitis B virus. The guidelines reflect  advances in the HIV response over recent years, including new technologies and approaches that allow decentralization of service delivery. They also provide operational guidance for strengthening early diagnosis and improving linkages and retention across the continuum of care.

Achievement of universal access will require more effective use of data to identify gaps in performance and improve programmes and services to meet targets. A culture of data use for programme improvement at all levels, from the facility level to national programme management, will be needed to improve uptake and retention of people living with HIV (PLHIV) and maximize the benefits of HIV care and treatment services for improved survival and reduced transmission of HIV. Identifying pregnant women, infants and tuberculosis patients who are HIV-infected, linking them to care and ART services, and promoting retention in care are important components of universal access to HIV care and treatment.

Monitoring and evaluation frameworks need to track the entire cascade of services, with greater attention to linkages and retention throughout the continuum of care. These metrics distill a core set of indicators to focus attention on the cascade of HIV care services, taking into account the prevention benefit of treatment, and integrates prevention of mother-to-child transmission (PMTCT) and the identification and treatment of TB/HIV co-infections.

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