Martin C. Donoghoe & Annemarie Rinder Stengaard WHO Regional Office for Europe

Access to antiretroviral therapy (ART) for injecting drug users in

the WHO European Region 20022008

Martin C. Donoghoe & Annemarie Rinder StengaardWHO Regional Office for Europe

XVIII International AIDS Conference Vienna 22nd July 2010 Abstract THAX0105

2Prepared for XVIII International AIDS Conference 2010 Martin Donoghoe

Background

• IDUs have poorer levels of access to ART compared with non-IDUs

• Provision of ART to IDUs has population-wide health benefits

• IDUs can successfully undergo HIV treatment and benefit from ART

• Antiretroviral therapy is one of nine interventions in the UNAIDS comprehensive package for the prevention treatment and care of HIV among IDUs.

• We examined IDU access to ART (equity and change over time) in Europe.

• We have reported that women and children have equitable access elsewhere


Cumulative number of reported casesin WHO European Region

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

1,100,000

1,200,000

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

HIVAIDSAIDS deathspeople on ART


New reported HIV cases (1989-2008)

010,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000

010,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000

1989199

0199

1199

2199

3199

4199

5199

6199

7199

8199

9200

0200

1200

2200

3200

4200

5200

6200

7200

8

010,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000Cumulative figures, most recent data:HIV cases: 507 590AIDS cases: 298 712AIDS deaths: 168 392

Cumulative figures, most recent data:HIV cases: 681 821AIDS cases: 38 766AIDS deaths: 15 987

Cumulative figures, most recent data:HIV cases: 39 712AIDS cases: 17 574AIDS deaths: 8 398

HIV

cas

es

HIV

cas

esH

IV c

ases


2%

<20%

20-40%

40-60%

60-80%

6%

5%

11%

9%

>80%

75%

25.5%

9%

5%

88%

57%

80%

28%

65%

57%

59%

16%

13%

17%

4%

15%

16%

<1%

23%

82%

50%61%

14%

71%

11%

5%

IDU as % of all HIV/AIDS cases with known transmission route

NOTE: % of AIDS cases in countries not reporting HIV: France, Italy, Spain Sources: WHO/ECDC joint reporting & national reports

11%

15%

26%

5%

77%

2%

17%

0%9%

1%

16%

24%

25%

16%

29%

76%

73%

73%

66%

78%

42%

4%

3%


Scaling up treatment in Europe (Patients on ART)

16,000

18,00021,000

396,000380,000

350,000335,000

320,000305,000

290,000266,000

35,000

87,000

55,000

27,00023,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

Feb-03

Apr-03

Jun-0

3

Aug-03

Oct-03

Dec-03

Feb-04

Apr-04

Jun-0

4

Aug-04

Oct-04

Dec-04

Feb-05

Apr-05

Jun-0

5

Aug-05

Oct-05

Dec-05

Feb-06

Apr-06

Jun-0

6

Aug-06

Oct-06

Dec-06

Feb-07

Apr-07

Jun-0

7

Aug-07

Oct-07

Dec-07

Feb-08

Apr-08

Jun-0

8

Aug-08

Oct-08

Dec-08

Central and Eastern EuropeWestern Europe


Objectives

• To examine IDU access to ART in Europe

– Equity (in access injectors and non injectors)

– Change over time (between 2002 & 2008)


Method (1)

• Four standardized national surveys were conducted between 2002-2008

• Annual WHO/UNICEF/UNAIDS reporting on health sector response to HIV/AIDS

• Sent to WHO counterparts in 53 European countries


Method (2)

WHO/UNODC/UNAIDS ART coverage for IDUs indicator

– Compares proportion of ever diagnosed HIV cases reported in the IDU transmission category with proportion of ART recipients in the same category

– Data were adjusted for HIV cases and ART recipients for whom HIV transmission route was unknown


Results

Two simple questions:

Do injectors have equitable access to ART ?

Are there changes in access over time?


Injecting Drug Users’ ART Access WHO European Region 2002 to 2008

Year 2002 2005 2006 2008

Number of reporting countries 27 33 38 30

HIV cases, IDUs (% among total reported HIV cases with known transmission route)

85 639(46%)

277 574(58%)

308 985(59%)

101 428(42%)

IDUs on ART (% among total reported people on ART with known transmission route)

4 120(10%)

48 277(32%)

51 352(30%)

52 506(31%)


Injecting Drug Users’ ART Access WHO European Region 2002 to 2008

0

10

20

30

40

50

60

2002 2003 2004 2005 2006 2007 2008

HIV cases IDUs IDUs on ART


Conclusions

• IDU access to ART in the European Region is inequitable

• Scant improvement in DUU access 2002–2005

• Little evidence of further progress 2006–2008


Implications & recommendations (1)

• Need to rapidly scale up IDU access to ART in Europe

• Substance use status – for example current injecting – should not be a barrier to access

• Restrictive policies should be lifted• Quality guidelines for providing ART to IDUs –

including recommended regimens that consider hepatotoxicity and drug-drug interactions – should be developed


Implications & recommendations (2)

• Services that integrate drug dependence and HIV treatment services are particularly effective

• Opioid substitution therapy has been demonstrated to improve both access and adherence to ART and should be made more widely available – particularly in Eastern Europe where coverage is particularly poor

• Rights HERE Right NOW for drug injectors


Contact Details

Martin C. DonoghoeProgramme Manager: HIV/AIDS, STIs & Viral HepatitisCommunicable Disease and Environmental Health Unit (CDS)

World Health OrganizationRegional Office for EuropeScherfigsvej 8, Copenhagen DK-2100Tel: +45 3917 [email protected]

Martin C. Donoghoe & Annemarie Rinder Stengaard WHO Regional Office for Europe

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