Last week I had the opportunity to share my reflections on what the 20th International AIDS Conference (AIDS 2014 ) means for our efforts to achieve the goals of the U.S. National HIV/AIDS Strategy. For an international perspective, I had an opportunity to sit down with Ambassador-at-Large and Coordinator of U.S. Government Activities to Combat HIV/AIDS, Deborah L. Birx, M.D., to talk about her reflections on the conference highlights. Ambassador Birx oversees the U.S.President’s Emergency Program for AIDS Relief (PEPFAR) and had a full agenda during AIDS 2014.
Watch our brief conversation below.
Among the conference highlights she discusses is an increasing focus across sectors on ensuring that low- and middle-income countries with high HIV burdens have access to and the capacity to utilize tests that monitor the levels of the HIV virus in the body (i.e., viral load). For treatment to be optimally effective, it is essential that all people on antiviral drugs to treat HIV have their viral load measured regularly. Advocates at AIDS 2014 called for routine viral load testing, so all patients can know if their medication is working and if they are “undetectable.” While it has become a standard part of HIV care in the U.S. and other developed countries, viral load testing technology is still too expensive for low-income countries and currently very few high-burden countries routinely offer viral load testing to people receiving HIV treatment.
During AIDS 2014, Médecins Sans Frontières (Doctors without Borders) released a study of viral load monitoring in five countries. Getting to Undetectable [PDF 1.23MB] describes viral load testing in India, Kenya, Malawi, South Africa and Zimbabwe and reveals that while these countries aspire to implement routine viral monitoring, almost none have been able to do so on a large scale. Also at AIDS 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS), along with global partners including PEPFAR, announced the launch of the Diagnostics Access Initiative , which seeks to expand access to viral load testing by supporting the development, deployment, and use of new viral load monitoring technologies. In the UNAIDS announcement of the initiative, Ambassador Birx observes, “To achieve control of the HIV/AIDS epidemic, it’s essential that all people have access to high-quality HIV laboratory services, both for accurate HIV diagnosis and treatment monitoring. Building a country’s capacity for virologic testing is critical for early identification of virologic failure, drug resistance and overall improved impact of the country’s HIV care and treatment programs. The Diagnostic Access Initiative represents an important step in ensuring the close collaboration among all donors and stakeholders to expand access and enable strategic scale-up of HIV laboratory services.”
Ambassador Birx also points to the release of the UNAIDS Gap report as another important conference highlight. The report both describes and illustrates key global HIV/AIDS facts and emphasizes the importance of location and population through an in-depth regional analysis of HIV epidemics and through analysis of 12 populations at higher risk of HIV. It explores the reasons for the widening gap between people gaining access to HIV prevention, treatment, care and support, and people being left behind. It shows how focusing on populations that are underserved and at higher risk of HIV will be key to ending the AIDS epidemic. (Learn more about the Gap report in this blog post from AIDS 2014.)