3 ways to close the HIV equity gap by Clinton Health Access Initiative (CHAI)

 

The theme for World AIDS Day 2022 is Equalize, highlighting the critical need to address inequalities that are holding back progress. 

CHAI was founded 20 years ago in response to the global AIDS crisis. At the time, many believed AIDS was an insurmountable problem. But over the last two decades, together with governments, partners, and communities of people living with HIV, we have scaled lifesaving treatment globally to over 28 million people – a feat once thought impossible.

At the beginning of this century, treating HIV cost over US$10,000 per person per year. CHAI’s pioneering work negotiating price reductions and generic licenses, together with critical efforts from partners like PEPFAR, the Global Fund, and Unitaid, has dramatically reduced the price of treatment to under US$50 per person per year today.

As a result, the outlook for adults and children living with HIV is far better. Yet work remains to ensure that everyone has equal access to the care they need. Here are three ways that we are closing the HIV equity gap in 2022 and beyond.
 

1.  Reducing preventable deaths from AIDS

Cryptococcal meningitis is the second leading cause of death in people living with HIV. Prior to the Unitaid-CHAI Optimal grant fluconazole was the only drug available to treat cryptococcal meningitis in many low- and middle-income countries, despite considerable evidence it is associated with suboptimal patient outcomes. Fluconazole monotherapy leads to an unacceptably high mortality rate of over 50 percent at just 10 weeks, compared to the optimal combination therapy of flucytosine (5FC) and liposomal amphotericin (L-AmB) – which cuts the mortality rate in half. Through Unitaid and CHAI’s catalytic procurement and support to governments, 5FC and L-AmB are now available in Uganda and across project focal countries.
 

2. Bold actions to end childhood AIDS

Among the 1.7 million children living with HIV today, almost half are not on life-saving treatment, viral suppression among children is very low compared to adults, and persistent geographic disparities remain. Without rapid action, these alarming inequities put children at greater risk of AIDS-related mortality.

But there is hope. HIV treatment for children has dramatically improved over the past year and a half thanks to a Unitaid and CHAI-led partnership to develop better medication. As a result of this partnership, the best available medicine for children (pDTG) has made its way into the hands of over 100,000 children in over 60 countries after being developed in record-breaking time. CHAI is supporting government partners in Benin, Nigeria, and Uganda to conduct research on the use of pDTG to treat children in real world settings.
 

3. Preventing HIV to control the epidemic

Reductions in HIV infections have stubbornly stagnated in recent years. Key and priority populations remain at disproportionate and high risk of infection. Encouragingly, the portfolio of HIV prevention options is expanding, positioning us for transformation. The injectable cabotegravir (CAB-LA) received US FDA approval in December 2021, and throughout 2022, CHAI worked closely with a range of stakeholders, including donors, communities, ViiV, and generic manufacturers to accelerate access to CAB-LA for those who need it most. 

However, impact for those in greatest need of HIV prevention options is still not guaranteed. Urgent, coordinated action is needed to support well-designed and timely evidence generation as well as market shaping, programmatic, and demand generation interventions to convert potential to impact.