2016

This document was created by ICAP’s Clinical and Training Unit with valuable input from our teams in Swaziland, Mozambique, Kenya, and Cote d’Ivoire. It was developed as a template document to be adapted for use in various contexts and is one component of a viral load monitoring tool-kit, to be used in conjunction with ICAP’s Viral Load Monitoring Flipchart and Enhanced Adherence Treatment Plan. This area is evolving rapidly therefore it is expected that this document will require frequent updating over time, as recommendations change, and needs to be adapted according to local guidelines and context.

A robust monitoring and evaluation (M&E) system is a key component of a strong health system. With the current WHO recommendation of lifelong ART for all pregnant and breastfeeding women living with HIV, outcomes (including maternal survival and final infant HIV status) require monitoring through longitudinal data systems complemented with regular cohort analyses and enhanced monitoring. Additionally, as we move toward the need for more strategic policies and programming to garner system and resource efficiencies, M&E systems need to be designed to be able to inform differences arising from age, sex, and geographic trends as well as identify weaknesses such as sub-optimal commodity supply and testing quality.

The international community has committed to ending the AIDS epidemic as a public health threat by 2030 – an ambitious target of the 2030 Agenda for Sustainable Development adopted by the United Nations General Assembly in September 2015. Interim targets have been established for 2020. This strategy describes the health sector contribution towards the achievement of these targets. It outlines both what countries need to do and what WHO will do. If implemented, these fast-track actions by countries and by WHO will accelerate and intensify the HIV response in order for the “end of AIDS” to become a reality.

The latest UNAIDS data, covering 160 countries, demonstrate both the enormous gains already made and what can be achieved in the coming years through a Fast-Track approach. In just the last two years the number of people living with HIV on antiretroviral therapy has increased by about a third, reaching 17 million people—2 million more than the 15 million by 2015 target set by the United Nations General Assembly in 2011. Since the first global treatment target was set in 2003, annual AIDS-related deaths have decreased by 43%. In the world’s most affected region, eastern and southern Africa, the number of people on treatment has more than doubled since 2010, reaching nearly 10.3 million people. AIDSrelated deaths in the region have decreased by 36% since 2010.

In 2015, the IATT monitoring and evaluation working group (MEWG) finalized and disseminated the IATT B+ M&E Framework. One mechanism used to disseminate was to convene a 15 Country Consultation that was determined as follows: the eight 2015 priority countries (Cameroon, Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda & Zambia) that contributed 70% of new infections among the Global Plan countries in 2013, three countries (Malawi, Rwanda and Zimbabwe) representing best practices from the region and four countries (Botswana, Cote d’Ivoire, DRC and Namibia) who are in the process of reviewing their M&E systems for B+ roll out.

The 2016 High-Level Meeting on Ending AIDS will focus the world’s attention on the importance of a Fast-Track approach to the AIDS response over the next five years. The UNAIDS Fast-Track approach aims to achieve ambitious targets by 2020, including:

1. Fewer than 500 000 people newly infected with HIV
2. Fewer than 500,000 people dying from AIDS-related causes
3. Elimination of HIV-related discrimination

The global commitment to ending the AIDS epidemic, as set forth in the 2030 Agenda for Sustainable Development, represents an unparalleled opportunity to end one of the most devastating modern-day health challenges and also to build on the momentum of the AIDS response in order to accelerate results across the sustainable development agenda.

Sixteen years of progress since the International AIDS Conference was last held in Durban. Millions of lives saved. But to end the AIDS epidemic there are new milestones to reach, barriers to break and frontiers to cross.