A new United Nations initiative aimed at providing anti-retroviral drugs to three million people in developing countries and those in transition by 2005 was unveiled on Monday as part of World AIDS Day.
Titled '3/5 strategy', the ambitious World Health Organisation and UNAIDS programme seeks to train tens of thousands of community health workers to support the delivery of medicines and for monitoring of millions suffering from HIV/AIDS in the worst affected countries, which face chronic shortage of doctors and other medical staff.
"Preventing and treating AIDS may be the toughest health assignment the world has ever faced, but it is also the most urgent," said Dr Lee Jong-wook, WHO director general. "The lives of millions of people are at stake. This strategy demands massive and unconventional efforts to make sure they stay alive."
"The 3 by 5 framework is a plan for action by a broad alliance of nations, institutions, and committed people, including those living with HIV/AIDS," said Dr Jack Chow, assistant director general of WHO for HIV/AIDS, tuberculosis and malaria.
"We urge all concerned to work to reach the 3 by 5 target as rapidly as possible."
Reaching the 3 by 5 target will require substantial new funding for AIDS treatment from all sources -- countries, donor governments and multilateral funding agencies. WHO has estimated that the extra funding required amounts to approximately US $5.5 billion over the next two years.
"We know what to do, but what we urgently need now are the resources to do it. We must waste no time in building strong alliances immediately to implement this strategy. Three million people are counting on it," Lee said.
The new strategy includes providing simplified and standardized tools to deliver anti-retroviral therapy, an effective and reliable supply of medicines, rapid identification, dissemination and application of new knowledge, and sustained support for the countries.
It envisages the creation of a Global AIDS Medicine and Diagnostics Service, or AMDS, which will ensure that poor countries have access to quality medicines and diagnostic tools at the best prices.
The service, to be operated by WHO, the United Nations Children's Fund, and other partners, will help countries to forecast and manage supply and delivery of necessary products for treatment and monitoring of AIDS.
AMDS will include a medicine and diagnostic evaluation component, which will ensure that manufacturers, products, procurement agencies and laboratories meet the international quality, safety and efficacy standards.
The plan will create a new corps of health workers in every province of 34 heavily impacted countries, but it is yet unclear whether sufficient funds will be available to make the new scheme a success.
Under the new plan, WHO will provide aggressive technical assistance to health-care providers, community organisations and government ministries in an effort to reach the ambitious target.
Health Global Access Project estimates that at present less than 5 per cent of the 42 million with AIDS globally have access to the medicines, which have dropped the mortality rate in rich countries by 70 per cent.
WHO said many countries have already demonstrated their commitment to this target. Immediately following the declaration of a global AIDS treatment emergency, the health agency said more than 20 countries requested collaboration with and input from it.
Teams have already visited Kenya, Burkina Faso, Malawi and Zambia. Other teams have done preparatory work in India, Ukraine and Sudan.
WHO said the teams will work with governments to identify and help remove obstacles so that anti-retroviral medicines can be provided quickly to people who need them most. Many other countries, including Russia, have also sought help.
The strategy has greatly simplified the recommendations for AIDS treatment regimens with the WHO-recommended regimens being cut from 35 to just four. All four are equally effective, WHO said.
Another key element, WHO said, is the simplification of monitoring so that easy-to-use tests such as body weight and colour-scale blood tests are used where more complicated and expensive tests for viral load and white cells counts are not yet available.
"The simpler tests, combined with clinical evaluation by adequately trained health workers, can be effective in monitoring the progress of AIDS, the effectiveness of treatment, and its side effects," it said.
The initiative, WHO said, complements the "groundbreaking commitments" made by the United States under President George W Bush's HIV/AIDS Initiatives ($15 billion for an enhanced AIDS response), the "pathfinding work" of non-governmental organisations and faith-based groups.
The efforts of pharmaceutical companies to reduce the price of AIDS treatment, the contribution of international foundations like the Bill and Melinda Gates Foundation, the initiative and hard work of many national and international agencies, and, "critically", the "ourageous contributions" of nations increasing their people's access to AIDS treatment are also commendable, it said.
The strategy acknowledges that the involvement of communities and community workers is essential to the success of this initiative, WHO said.
One of the elements of the strategy is "learning by doing". It addresses many of the obstacles that have up to now prevented millions of people in poor countries from accessing AIDS medicines. The strategy will evolve as lessons learnt from implementing the strategy are identified and rapidly applied.
