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

2. 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

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

4. New HIV Infections 2014 – 2016
SEAR New HIV Infections
New HIV Infections 2016 per country (absolute, regional proportion and national rate per 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

5. 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 –
Estimated annual AIDS-related deaths (absolute, regional proportion and national rate per 1000 PLHIV)

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

7. SEAR Fast-Track Targets
reduce new HIV infections to below 50,000 in 2020 and below 20,000 in ; 150,000 as on December 2016
reduce HIV-related deaths to below 45,000 in 2020 and below 18,000 in ; 130,000 as on December 2016
Increase number of persons on treatment to 2.83 million in 2020 and 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.

8. 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

9. 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

10. 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

11. Ending AIDS – What will it take?

13. 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.

14. 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

15. SEA Region bears ~ half the global burden of TB disease

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

17. MDR-TB

18. Current efforts are not sufficient

19. SEA Region trends
Source: Ending TB in the SEA Region: Strategic Plan

20. Regional efforts so far

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

22. Statement of Action, 2018

23. Elements of Statement of Action1
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

24. 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

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

26. 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

27. 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

28. THANK YOU