Getting to Zero: Country perspectives

Nenet Ortega – CNS
“Getting to Zero” is UNAIDS’ strategic mantra for attaining zero new infections, deaths and discrimination. To get there, countries are expected to adopt innovating preventive approaches, scale up and scale out treatment care and support, and advance human rights while capitalizing on gender equality to mitigate discrimination and stigma.

At ICAAP on Wednesday, three countries shared different approaches in getting to a specific zero: deaths among positive clients attending treatment care and support in their facilities. A medical team in Yunnan (China) initiated scaling up of antiretroviral therapy. The team worked collaboratively with a community heavily affected by the epidemic. In 2010, only 5,000 people were on antiretroviral therapy (ART) and by end of 2011 it rose to more than 7,000. Part of the ‘zero deaths’ treatment package is counselling to make sure that clients understand what it is to initiate and enrol on ART, its benefits and potential side-effects.

The community is a constant partner in providing the psychosocial services and family members are trained on provision of home-based care support services to assist family member on ART. Clients on ART are constantly followed up to monitor the health and have tests to make sure that they are responding to the treatment. By the end of 2012, clients on ART increased to about 38,000. Average CD4 counts have increased from 200–250 to 650. In six months time, average viral load reduction was 70%. Annual deaths were reduced to 3 per 100. This is a two-year pilot initiative with a potential of larger roll-out if and when resources are made available.

A similar initiative was implemented in Karnetaka, in South India. Intensifying AIDS-related care and support at the community level, involving families and community support systems proved to be beneficial to clients initiated on ART, as well as treatment for opportunistic infections. Mortality due to opportunistic infections was reduced.

Thailand, known for its progressive and pro-active approach to providing comprehensive care through a government financing scheme, embarked on detecting early warning signs of ARV resistance, which could potentially lead to avoidable deaths.

A related initiative has been rolled out in Indonesia focusing on prevention ART stock-outs, ensuring that clients on ART get sustained supplies of medication. Skipping ARV doses may lead to resistant virus. Indonesia previously obtained their supplies from the national health office. This mechanism delayed drug distribution, leaving provincial ART hubs without timely supplies for distribution. To avoid stock outs, ART provision was decentralized to the provincial level directly. Numbers of clients lost to follow up because of lack of ART availability was reduced by almost 90%. CD4 counts increased and improvements in the health status of clients were achieved.

These are three different approaches for providing treatment and care services that lead to improved lives and adherence, better prognosis and fewer deaths. Three different countries with different approaches of contributing to zero deaths, all engaged families and communities, with services provided holistically.

Each of these countries recognize that in order to achieve zero deaths, treatment, care and support must be addressed by a team approach, including medical staff, families and community support systems. Intensified information and education within the community, and engaging community support systems, creates an enabling environment that leads towards zero discrimination. These actions, coupled with scaled-up treatment, care and support ultimately leads to zero new infections.

Nenet Ortega, Citizen News Service – CNS
November 2013

Note: This article was first published in 11th ICAAP INSIGHT, the official daily conference newspaper of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) in Bangkok, Thailand. This newspaper was managed by Inis Communication and CNS.