Update on HIV and TB situation in SEAR Dr Mukta Sharma RA HIV TB HEP WHO SEARO Global Fund , South-East Asia Constituency Meeting, 23-24 April 2018, New Delhi

HIV/AIDS continues to be a major public health problem Overall adult prevalence in SEAR region is low (0.3%) Approx. 10% of all PLHIV live in SEAR, an estimated 3.5 million, of these 39% are females 99% of these 3.5 million are in five countries, India, Indonesia, Myanmar, Nepal and Thailand Nearly 1.6 m are on ART Nearly 150,000 new infections and 130,000 AIDS related deaths occurred in SEAR in 2016

HIV Prevalence in Key Populations Epidemic is concentrated among key populations in most countries in SEA

New HIV Infections 2014 – 2016 SEAR New HIV Infections 2014 - 2016 New HIV Infections 2016 per country (absolute, regional proportion and national rate per 1000 population) two thirds of the new infections are still occurring in key populations, PROGRESS REPORT ON THE PUBLIC HEALTH RESPONSE TO HIV IN THE WHO SOUTH-EAST ASIA REGION

HIV Mortality 2014 – 2016 Since the introduction of ART in the region in 2005, AIDS-related deaths have almost halved. However, annual progress has been slow, especially for the adult population Estimated AIDS-related deaths in SEAR 2005, 2014 – 2016 Estimated annual AIDS-related deaths 2016 (absolute, regional proportion and national rate per 1000 PLHIV)

Getting to 90-90-90 Regional Cascade of testing and treatment 2016

SEAR Fast-Track Targets reduce new HIV infections to below 50,000 in 2020 and below 20,000 in 2030; 150,000 as on December 2016 reduce HIV-related deaths to below 45,000 in 2020 and below 18,000 in 2030; 130,000 as on December 2016 Increase number of persons on treatment to 2.83 million in 2020 and 3.3 million by 2030; 1.4 million as on December 2016 By 2020 reduction in new infections by 72% By 2020 reduction in HIV-related deaths by 67% By 2020 – double the numbers of person on life-saving antiretroviral.

Key issues/challenges Two thirds of the new infections are still occurring in key populations, Prevalence among PWID and MSM continue to be high in some countries Newer forms of sex work, Migration & networks of MSM, TG, PWID are posing challenges and lack of access to real time data at local level for action is a barrier Sustaining coverage & intensity in areas where declines have been achieved is critical to consolidate gains

Key issues/challenges Though all countries have adopted TREAT ALL policy, reaching out to first 90 is challenging in most countries ART coverage in region is 47% , varies widely between countries and is a slow as 20% in one country Decline in new infections has slowed down post 2015 Private sector involvement is not adequate enough, especially for elimination of MTCT in high burden countries Preventing and tackling HIV drug resistance

Key issues/challenges While most countries are providing free treatment services, declining donor funds have impacted prevention activities, IEC , community involvement etc. Barriers on accessing services by KP need to be addressed Six countries criminalize same-sex relations Four impose criminal penalties for sex work Four operate detention center for drug users No statistics but members of key population report discrimination in healthcare settings Ensuring social protection schemes for people infected and affected with HIV/AIDS Ensuring a stigma free environment

Ending AIDS – What will it take?

It is possible to achieve Fast-track targets Identify high risk communities, geographically and key populations Design impact interventions, engaging communities to be part of the response Front-load investment, especially on testing, diagnosis, and linkage to care Create an enabling environment – Zero discrimination in laws, regulations, policies, and especially in the health sector Strengthen information systems – progress needs to be monitored at local level It is possible to achieve Fast-track targets but need smart programming and impact interventions, Recalling that 5 countries are responsible for 99% of HIV cases in SEAR, it is possible to meet the targets in remaining 6 countries that account for a much smaller burden of HIV, both in absolute and relative terms. For the top five countries –there is variation – Thailand is well on the way to meeting its targets; but other countries need to make a big push. Of great concern is Indonesia, where most of the new infections (73,000 in 2015 of the 180k in region) are taking. India is also losing momentum.

Vineet Bhatia Technical Officer-TB/ WHO-SEARO Status of tuberculosis and measures to control tuberculosis in South-East Asia Vineet Bhatia Technical Officer-TB/ WHO-SEARO

SEA Region bears ~ half the global burden of TB disease

SEA Programme performance Closing gap between case notification and incidence, yet ~ 2 million missing Worrying decline in treatment success of DS-TB cases

MDR-TB

Current efforts are not sufficient

SEA Region trends Source: Ending TB in the SEA Region: Strategic Plan 2016-20

Regional efforts so far

Delhi Call for Action, 2017 Political commitment has never been at such a peak

Statement of Action, 2018

Elements of Statement of Action 1 LEAD implementation of the national TB responses in countries by an empowered national initiative that reports to the highest levels of government in Member States 2 INCREASE budgetary and human resource allocations by governments as well as by their global, domestic and other partners so as to ensure that national TB plans are fully funded 3 ENABLE the best possible care to each and every person, including migrants, the aged and other high-risk populations, living with any form of TB (through newer strategies) 4 SUPPLEMENT medical care for TB with…social and financial protection in a holistic manner

Empowered National Initiative Patient Centred Approach Ensure Universal Access to high quality TB care 11/11 11/11 Adopted the principles of a ”patient-centred approach 11/11 Increasing case finding, and case notifications and Improving treatment outcomes Improving diagnosis and management of MDR-TB High level Commitments to END TB High level national mechanism to direct implementation of NSP 4/11 10/11 5/11 Plans to engage civil society organizations Laid out plans to engage sectors outside the NTPs Current situation 3/11 2/11 2/11 Establishing Multi-sectoral collaboration Countries may meet targets of ”zero catastrophic costs” by 2020 Plans to address the development of new tools

TB Funding 114% 245 million US$ 2016 525 million US$ 2017

Way forward – Member States Establish multisectoral and empowered national initiatives in all Member States Develop a national accountability framework Estimate the financial resources needs for ending TB Define a minimum standard package for universal access

Way forward – partners and WHO Front load and scale up investments in high burden countries to cover current financing gaps Establish financing channels for innovations Define non-health elements of interventions and standardize unit costs Innovation to Implementation (I2I) fund that would support innovation

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