HIV - Q4 2020

Q4 / 2020

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HIV & TB Awareness Read more at www.globalcause.co.uk

Winnie Byanyima, Executive Director of UNAIDS (in blue jacket), meeting Juliana Atieno and children in the Kiambiu informal settlement in Nairobi in 2019 © U N A I D S/ B R I A N OTI E N O

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“There are 38 million people living with HIV, out of whom more than 12 million are still waiting for life-saving treatment.”

“Tuberculosis (TB) is one of the common and most harmful infections people living with HIV are at risk of contracting.”

“The move online to deliver clinical care in HIV prevention and treatment has been a great innovation learnt from the COVID-19 pandemic.”

Winnie Byanyima Executive Director, UNAIDS

Dr. Siobhan Crowley Head Of HIV, The Global Fund

Dr Sanjay Bhagani President-elect, EACS

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IN THIS ISSUE

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The fight against HIV is far from over

‘Global solidarity, shared responsibility’ is this year’s World AIDS Day theme.

It could not be more poignant as we tackle the ongoing global pandemic.

C

“Community initiatives are often considered second-class but in fact, we are creating a new model of intervention that is showing good results.”

Michael Meulbroek Co-Founder and President, BCN Checkpoint

08 “The role of communities, and the use of digital tools and well-established partnerships, have been key to ensuring access to treatment.”

Greg Perry Assistant Director General, IFPMA

10 “In England there’s the very real opportunity to be the first in the world to end new cases.”

Dame Inga Beale HIV Commission Chair Senior Project Manager: Gabrielle Dunn gabrielle. dunn@mediaplanet.com Business Development Manager: Ross Bannatyne Managing Director: Alex Williams Head of Business Development: Ellie McGregor Head of Production: Kirsty Elliott Designer: Thomas Kent Digital Manager: Harvey O’Donnell Paid Media Manager: Ella Wiseman Production Assistant: Henry Phillips Mediaplanet contact information: P:+44 (0) 203 642 0737 E: uk.info@mediaplanet.com All images supplied by Gettyimages, unless otherwise specified

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WRITTEN BY

Winnie Byanyima Executive Director, UNAIDS

OVID-19 has magnified and worsened the deep inequalities that run through our societies.

It has also forced people to recognise that our global health and economy are intricately linked.

In order to protect the hard-fought gains made in health, poverty reduction and development over the past 20 years, and get the global economy moving again quickly, the world must come together in action.

Keeping our commitment to eradicating HIV Before COVID-19 hit, we were not on track of defeating to end the AIDS epidemic by 2030. There are 38 million people living with HIV, out of whom more than 12 million are still waiting for life-saving treatment.

In 2019, 1.7 million people became newly infected with HIV, and 690,000 people died of AIDS-related illnesses.

This is shocking and unacceptable. Our fight is not over – yet it has just become a lot more difficult.

At UNAIDS, we are very concerned about the colliding pandemics of HIV and COVID-19 and what this means for people living with HIV and for vulnerable populations.

1.7 million people became newly infected with HIV, and 690,000 people died of AIDS-related illnesses.

Solidarity within communities We are heartened by the outstanding display of solidarity by communities

38 million people are living with HIV, out of whom more than 12 million are still waiting for life-saving treatment.

– in particular HIV communities – who have been front and centre of the COVID-19 response. Just as they have been, and continue to be, in the fight against HIV. With health at the top of the political agenda, we have an opportunity for building a better future. To end COVID-19 and HIV we must place human rights and dignity of all people at the centre of our responses. That’s the lesson we learned from HIV. As a first COVID-19 vaccine candidate has proven effective and a safe vaccine is expected to be available soon, there are serious threats to ensuring equitable access for all.

Learning from mistakes We cannot repeat the mistakes we made in the early years of the HIV response when antiretroviral treatments (ARVs) were available. Prices were so high that only people in rich countries were getting ARVs and millions of people were dying in poor countries.

‘Global solidarity, shared responsibility’ must be the mantra also to defeat COVID-19. Only then will health stop being a privilege, and truly be a human right, for each and every one of us.

UNAIDS is proud to be part of the People’s Vaccine alliance, calling for a COVID-19 vaccine to be a global public good, available to everyone everywhere free of charge at the point of use. This means maximising production by sharing technology, without enforcement of monopolies. bit.ly/ covidpeoplesvaccine

©UNAIDS/S.Dara

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People protecting people and communities from HIV

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he response to COVID-19 reflects what communities have been doing in helping to tackle HIV and AIDS for years. Individuals around the world are being armed with the knowledge to stop the spread of COVID-19 and protect others by first protecting themselves.

We have witnessed incredible strides to halt the spread of HIV, offering a future to those with the virus through advancements in treatment and care.

Building capacity for 20 million people over 20 years Luckson Soda, Country Director for Zimbabwean NGO, DAPP Zimbabwe is a pioneer of the TCE program. He reflects on 20-years fighting AIDS, “my experience in epidemic control at the community level has taught me that effective health responses must put the affected people at the centre of the solution. It is true for HIV, TB and other communicable diseases, and it is true for COVID-19.”

future to those with the virus through advancements in treatment and care.

However, the pace of progress does not currently match the global ambition and faced with COVID-19; we must prepare to miss the UNAIDS 90-90-90 targets and refocus our efforts in the years to come.

Rikke Viholm, Country Director for Angolan NGO, ADPP Angola, says that whilst the impact of COVID-19 is being felt, “we cannot lose sight of the global commitment to achieve zero new HIV infections, zero discrimination and zero AIDS-related deaths. We need to continue listening to the voices of the communities most affected by HIV; we must hear the people at all levels of this response.”

©DAPP NAMIBIA

COVID-19 has shaken health responses around the world and shone a light on the importance of equipping individuals and communities with the knowledge to take control of their health. We must continue the fight against HIV and AIDS.

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We need to continue listening to the voices of the communities most affected by HIV; we must hear the people at all levels of this response.

Global solidarity and shared responsibility COVID-19 has the possibility of setting back progress made in the fight against HIV by decades. It could reverse hardearned gains if health systems are overwhelmed, treatment programs disrupted, and funding diverted.

Kirsten Moeller-Jensen, Director of Namibian NGO, DAPP Namibia, acknowledges change is needed in light of the pandemic. She says, “we must leverage existing infrastructure, trust and relationships to rapidly meet the challenges presented by COVID-19.

In Namibia, we are working with the Ministry of Health and CDC to roll out multi-month dispensing so people can reduce visits to collect ARV treatment, reducing their risk of contracting COVID-19 and stopping congestion at health facilities.”

Refocussing efforts for HIV targets We have witnessed incredible strides to halt the spread of HIV, offering a

What is required now to end the epidemic?

Women and adolescent girls are disproportionately affected because of vulnerabilities created by unequal cultural, social and economic status.

Kilford Zimondi, County Director of South African NGO, Humana People to People says “we must ask ourselves, what is required now to end the epidemic? The groups still left behind are the most vulnerable and hardest to reach. It is these groups that are in one way or another often not legally recognised or protected, further complicating our ability to effectively reach them with lifesaving information and care.”

In these contexts, community mobilisation needs to remain central to fighting HIV and AIDS to address the continuing challenges in accessing testing and treatment, so often driven by fear, stigma and discrimination.

WRITTEN BY

Snorre Westgaard Chairman, Humana People to People

Paid for by Humana

Listen, understand, respond Whether related to HIV, TB, or COVID-19, we need to listen to, understand, and respond to the complex and individual needs of the people affected, putting people at the heart of the design and delivery of health services.

Now, more than ever, we are reminded of the power of individuals and community health response to overcome challenges. We (Humana People to People) always have and will continue to stand with people and our partners to protect those in need.

Humana People to People is an international federation of 30 NGOs and social enterprises working with partners in 45 countries to support people and communities to overcome some of the world’s major humanitarian, social and environmental challenges.

It pioneered the community led HIV and AIDS programme, Total Control of the Epidemic (TCE) 20 years ago.

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TB and HIV groups often experience greater difficulty accessing health services due to stigma and discrimination, violence, harassment or restrictive laws or policies.

Fighting HIV and TB co-infection in the shadow of COVID-19 Showcasing the link between HIV and TB is vital to understand the risks and impact on the most vulnerable in society.

WRITTEN BY

Dr. Siobhan Crowley Head of HIV , The Global Fund to Fight Aids, Tuberculosis and Malaria

What is HIV/TB co-infection?

A co-infection is the occurrence of two or more infections – at the same time.

HIV is a preventable chronic infection, that when left untreated damages and weakens the immune system. This puts people living with HIV at greater risk of infections and cancers.

Tuberculosis (TB) is one of the common and most harmful infections people living with HIV are at risk of contracting. People with HIV are 18 times more likely to develop active TB compared to people without HIV. TB is still the leading cause of death among people living with HIV. Who are the people primarily affected by HIV/TB co-infection?

People living with HIV are at risk of developing active TB. TB is airborne, so when a person living with the disease coughs, sneezes, shouts or sings, droplets containing TB are released.

Depending on the environment, these particles can remain suspended in the air for several hours. Therefore, people who live or work in crowded places, with bad ventilation (prisons, slums, mines), bad quality of air or greater time

of exposure like healthcare workers are at greater risk of TB infection.

The poorest and most marginalised communities are also most at risk of HIV. TB and HIV groups often experience greater difficulty accessing health services due to stigma and discrimination, violence, harassment or restrictive laws or policies.

People with HIV are 18 times more likely to develop active TB compared to people without HIV. In the context of HIV, this includes sex workers, people who inject drugs, men who have sex with men, transgender people and people in prison and detention. In the context of TB, this can also include migrants, refugees, miners and indigenous populations.

What impact has the COVID-19 pandemic had on HIV and TB? COVID-19 has widely disrupted health service delivery and demand worldwide. Lifesaving treatment and prevention activities for people with HIV and TB has been interrupted, increasing the risk of drug resistance and deaths.

The latest data provided by the WHO has shown significant reductions in TB case notifications, with a 25-30% drop reported in three high burden countries – India, Indonesia, the Philippines – between January and June 2020 compared to the same sixmonth period in 2019.

If people are not tested and treated, they can continue to transmit the disease to others, or die. This is a tragedy. It may derail years of progress against HIV and TB. The international community must urgently invest far greater resources in the fight against COVID-19 and to mitigate its devastating impact on the fights against HIV and TB.

The Global Fund is playing a critical role in the global response to COVID-19 by providing up to US$1 billion to support response in more than 100 countries. These funds aim to maintain essential health services, mitigate the impact of COVID-19 on HIV, TB and malaria, purchase and distribute tests, and provide personal protective equipment to frontline health workers. theglobalfund.org

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Tackling HIV in Eastern Europe and Central Asia (EECA) matters With HIV on the rise in EECA, a ground-breaking partnership is helping to tackle HIV in the region.

This article was written by Korab Zuka with contribution from Anne Aslett.

WRITTEN BY

Korab Zuka Vice President, Public Affairs, Gilead Sciences

WRITTEN BY Anne Aslett Chief Executive Officer, Elton John AIDS Foundation

T

o many, the first few months of the COVID-19 pandemic felt uncomfortably similar to the early years of the HIV epidemic, with the same fear, stigma, and speculation about how they are transmitted.

COVID-19 has now been in our lives less than a year but is still affecting us all.

Nearly 40 years on from the start of the HIV epidemic, it is at risk of becoming an afterthought despite its ongoing impact on the lives of millions worldwide, especially in regions where HIV rates are increasing.

HIV is on the rise in EECA Although the global community has the tools to end the epidemic, HIV is still rising in EECA, where an estimated 1.7 million people live with HIV.1 While new infections have declined by 37% and deaths from AIDS-related illnesses have halved globally over the last 20 years, in EECA, new infections have increased by 183% and deaths from AIDS-related illnesses have risen by 190%.1

We have to act now “We cannot leave the people in EECA behind. To end HIV by 2030 worldwide, we must act now,” says Anne Aslett, Chief Executive Officer, Elton John AIDS Foundation. “To see the same progress in EECA that we are seeing globally, we must work together to ensure everyone – including the most vulnerable – has equal respect, support, and access to care.”

Local communities and leaders are working on local solutions, but the magnitude of the epidemic in EECA means that additional funding and support is urgently needed.

Helping to tackle HIV in EECA Recognising these needs, Gilead Sciences partnered with the Elton John AIDS Foundation to launch RADIAN in 2019. This ground-breaking, fiveyear partnership is supporting and strengthening proven models of prevention and care in EECA. The first grantees of the RADIAN Unmet Need fund are already

To see the same progress in EECA that we are seeing globally, we must work together to ensure everyone – including the most vulnerable – has equal respect, support, and access to care. delivering vital support to people in EECA, while in Almaty, Kazahkstan, the first RADIAN Model City, six organisations are working closely with local government to strengthen the city’s HIV response.

“When we launched RADIAN, we had no idea we would be facing the significant global health threat of COVID-19. The pandemic has affected us all, but for those living with HIV in EECA the role of local initiatives, like those supported by RADIAN, are more important than ever,” says Anne Aslett. “Despite the challenges posed

by COVID-19, the RADIAN grantees have demonstrated significant results and we look forward to seeing how their work creates real change for those in the region, both now and in the future.”

References 1. UNAIDS Data 2020. Available at: unaids.org/en/resources/ documents/2020/unaids-data [Accessed November 2020]

Paid for by Gilead

To find out more visit radianhiv.org

Job no: IHQ-HIV-2020-11-0036 Date of preparation: November 2020

HIV prevention is in crisis The global response to COVID-19 has shown what’s possible. Now we need the same commitment to ending AIDS. INTERVIEW WITH

Lois Chingandu Director Evidence and Influence, Frontline AIDS WRITTEN BY

Ailsa Colquhoun

Paid for by Frontline AIDS

A

IDS isn’t over. We may have effective treatments and innovative prevention tools, but we have failed to get new HIV infections under control.

By 2020, the goal was to achieve fewer than 500,000 new infections annually.

Judging by the 1.7 million new infections we saw in 2019 – a figure that has barely changed in the past four years – the world has failed badly in meeting this target.

HIV infection drivers In Eastern Europe and Central Asia, new HIV infections have jumped by two thirds in the last decade, and in the Middle East and North Africa by 22%. In Africa, although rates of infection are coming down, HIV remains the leading cause of death in women of reproductive age. It is also the second most common cause of death in adolescents.

Although we have a range of biomedical interventions such as male circumcision and Pre-Exposure Prophylaxis (PrEP), significant social and legal barriers remain. If we’re serious about ending AIDS, we must address the social and gender norms that are fuelling the HIV epidemic, and repeal laws that criminalise same-sex relationships, drug use and sex work.

The impact of COVID-19 COVID-19 has made things worse, disrupting HIV prevention services such as the provision of condoms, PrEP and harm reduction for people who use drugs. Health systems are crumbling and already fragile and vulnerable people are being pushed into poverty, which is going to particularly expose young people to higher HIV risk.

Restrictions imposed to curb COVID-19 are making many even more vulnerable to HIV. Sexual and genderbased violence increases HIV infection risk for women and girls, and our partners report that this has increased dramatically under lockdown.

Some governments are using COVID-19 restrictions to crack down on people who are already marginalised.

In the three months after the onset of COVID-19, we saw applications to our emergency Rapid Response Fund for marginalised groups triple.

We’ve supported sex workers unable to feed their families because they’re being turned away from food aid and provided funds to keep needle and syringe programmes and opioidsubstitution therapy running for people who use drugs. In Uganda our partners helped secure the release of 20 young LGBT people who were

By 2020, the goal was to achieve fewer than 500,000 new infections annually. arrested and imprisoned under the guise of COVID-19 restrictions.

Courageous decisions In responding to COVID-19, governments have shown that they can make unprecedented decisions when faced with a health crisis. But HIV prevention is in crisis too, and we must not let that be ignored as attention and resources are mobilised to fight COVID-19.

We need governments to show the same commitment and to finally address the barriers to HIV prevention.

HIV is not a new pandemic, but courage and leadership are needed now more than ever.

To find out more visit frontlineaids.org/ worldaidsday

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Locked down, but not out – how COVID-19 has changed HIV services Shared knowledge and experience of HIV care during COVID-19 have changed HIV services for the better, and possibly for good.

INTERVIEW WITH:

Dr Sanjay Bhagani President-elect, EACS, Infectious Diseases/HIV specialist

WRITTEN BY

Ailsa Colquhoun

The European AIDS Clinical Society is a not-for-profit organisation whose mission is to promote excellence in standards of care, research and education in HIV infection and related co-infections, and to actively engage in the formulation of public health policy, with the aim of reducing HIV disease burden across Europe. eacsociety.org

©RIDOFRANZ

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ew things have benefitted testing is different, driven by different from the COVID-19 resources, differences in workforce and pandemic, but the move their ability to deliver care.” With no online to deliver clinical ‘standard’ training in HIV, services may care in HIV prevention and be delivered by genitourinary medicine treatment has been a great or infectious disease specialists as they innovation, says Dr Sanjay Bhagani, are in the UK, or by respiratory or other President-elect of the European AIDS specialities as happens elsewhere. “But Clinical Society (EACS). patients should be able to expect at least Online the same minimum, consultations, evidence-based coupled with healthcare practices, medicines delivery wherever they are services, have based,” he says.

As clinicians our aim proved popular with is to normalise life for patients. Dr Bhagani Why U = U says: “The vast A key element of people living with HIV/ majority say they can EACS guidelines get on with their lives AIDS and making people and messaging is rather than spend the principle of take hours out of their three to four hours ‘U = U’ – where day to visit a clinic is far visiting a clinic. As an undetectable from doing that. clinicians our aim viral load equals is to normalise life untransmissible for people living with HIV/AIDS and virus. The EACS also aims to define making people take hours out of their standards in HIV treatment as well as day to visit a clinic is far from doing providing training and drive public that. We think this new way of doing health agenda. Dr Bhagani says: “If things is far better for patients and for we can get people onto treatment local healthcare teams.” early, we can reduce infections, as well as comorbidities, which in turn Standardising care significantly reduces health costs.”

Online networking has also been Being able to share best practice and vital to sharing knowledge amongst reach patients easily have been real specialists across countries in the field positives to come out of COVID-19, and of HIV. Innovation of this type has Dr Bhagani believes some practices will been important, he says, in order to change permanently as a result of the standardise progress across Europe experiences that have been shared. He towards attainment of the UN HIV says: “If anything, COVID-19 has spurred goals – both in terms of practices us on to do even better. Where there is and provision of care. Dr Bhagani determination to succeed, we are finding says: “Depending on the country, that we can really make a difference.”

INTEGRATED TESTING IN COMMUNIT Y AND HEALTHCARE SETTINGS P I O N E E R I N G T H E WAY IN RAPID STI TESTING

1. Mourez T, et al. HIV rapid screening tests and self-tests: Be aware of differences in performance and cautious of vendors. Rouen Uni 2. Amini A, Varsaneux O, Kelly H, et al. Diagnostic accuracy of tests to detect hepatitis B surface antigen: a systematic review of the lite 3. Downing RG, Forssten C, Kabbale P, Newton R, Robins T, Tamanoue Y. Determine™ HBsAg 2: A novel rapid test for the detection of 4. World Health Organization. WHO performance evaluation acceptance criteria for HBsAg in vitro diagnostics in the context of WHO © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respect

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Preventing HIV infection through community clinics

“W INTERVIEW WITH

Michael Meulbroek Co-Founder and President, BCN Checkpoint

WRITTEN BY

Ailsa Colquhoun

e all are part of the solution,” says Michael Meulbroek, Co-Founder and President of BCN Checkpoint, a community-based sexual health service in Barcelona.

Located in the heart of the Catalan city’s gay community since 2006, the service has helped many thousands of gay men infected with HIV to better health, as well as reducing infections within the wider gay male community.

Accessible support Peer counselling and support, linked to same-day testing, confirmation and early access to medical care, are fundamental in helping people living with HIV to adopt an active and responsible approach to their condition.

It will also ensure they are receiving the appropriate treatment quickly.

National HIV surveillance data indicate that BCN Checkpoint has been responsible for the detection of over a third of HIV diagnoses, facilitated by a four-fold increase in the number of persons presenting for yearly tests (between 2007 to 2012). It also reported a 23-fold increase in the number of people returning for a repeat test. Two long-term studies also show a 62% reduction in the incidence of HIV in the area. For Meulbroek an important factor in the centre’s results is the support offered by its all-gay staff.

©IMAGE PROVIDED BY BCN CHECKPOINT

Community based clinics have proven their role in the earlier detection, treatment and support for people with infections such as HIV.

What people most want is to talk to somebody who has the same experience.

And that, I think, is our greatest asset.

In Spain, as in many other countries, LGBT (lesbian, gay, bisexual and transgender) people may fear stigma, homonegativity and discrimination from health care providers, which can discourage early take-up of prevention, testing, care and treatment. This encourages poorer health and societal outcomes for the infected person, as well as increases the ongoing infection risk within the wider gay community.

Meulbroek says: “In any pathology, physicians, psychologists…. are important. But in fact, what people most want is to talk to somebody who has the same experience. And that, I think, is our greatest asset.”

Preventing transmission Over the past year BCN Checkpoint has added to its gay community support offer by providing PrEP (a

drug treatment that can prevent HIV infection). It is also now offering testing and treatment for a range of sexually transmitted infections such as gonorrhoea, chlamydia, syphilis, and hepatitis A, B (and, soon, C) some of which can be asymptomatic in men.

PrEP is a very new treatment in Spain, but after just one year, BCN Checkpoint has around 1,400 men taking PrEP on its books, plus there is a long waiting list – again proving its value as a provider of public health, says Meulbroek. He concludes: “Community initiatives are often considered second-class but in fact, we are creating a new model of intervention that is showing good results. And these good results should equate to adequate funding. “It’s time that the health service considered us equal partners in public health.”

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iversity Hospital, Laboratory of Virology associated to the National Reference Centre for HIV. 2018. erature and meta-analysis. BMC Infect Dis. 2017;17(Suppl 1):698-716. f hepatitis B virus infection. Poster session presented at: 28th Conference of Asian Pacific Association for the Study of the Liver; February 20-24, 2019; Manila, Philippines; based on package inserts or other company-produced material in public domain.

O prequalification. https://www.who.int/diagnostics_laboratory/evaluations/hepb/161125_who_performance_criteria_hbsag_ivd.pdf?ua=1. Accessed January 29, 2019. tive owners. Any person depicted in such photos is a model. 120007603-01 11/20

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HIV and tuberculosis: Ensuring people’s access to treatment during the pandemic

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As the global coronavirus pandemic continues, we need to maintain continued access to HIV and TB essential medications worldwide.

T WRITTEN BY

Greg Perry Assistant Director General, IFPMA, Former Executive Director, Medicines Patent Pool

he COVID-19 pandemic has claimed more than 1.2 million lives, and many more deaths have likely gone unreported. The life science industries, governments, researchers, and numerous public health organisations are all working together to find vaccines, treatments and diagnostics to battle the pandemic.

However, we also know that the pandemic has created challenges in maintaining supply of essential medicines in other treatment areas such as HIV and tuberculosis (TB).

Communities help bridge the gap In response, partners throughout the supply chain have worked endlessly to keep HIV and TB treatments available. This includes collaboration with innovative bio pharmaceutical industry, manufacturers, freight companies, regulators, procurement agencies, multilateral agencies governments, NGOs and on-the-ground distributors.

This collaboration, paired with robust supply chain management systems and experienced in-country distribution, has helped. The role of communities, and the use of digital tools and well-established partnerships, have been key to ensuring access to treatment.

The innovative biopharmaceutical industry has also made a significant effort to keep research and development programmes on track.

Managing supply chain Rapid in-country response to the severe supply gap projections has been significant in limiting the impact and/ or ensured timely “bounce-back” of prevention services, testing and prevention of mother-to-child transmission (PMTCT). Those who responded quickest could benefit from the infrastructure built on years by initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and Global Fund aid.

In the field of TB, the Global Drug Facility (GDF) has been critical, working with companies and organisations on the ground to prevent shortages and create a stockpile of first line treatments.

Numerous business and healthcare stakeholders also made resounding demands to stop treatment nationalism which threatened severe disruption, especially on the African continent.

In addition to its strong supply management, the innovative biopharmaceutical industry has also made a significant effort to keep research and development programmes on track so innovation in HIV and TB is not slowed by the pandemic.

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Innovation and collaboration will lead to prevention At the last Global Fund Replenishment conference the industry committed to step up the fight, do more, innovate more, and partner more to ensure access to innovative treatments for people living with HIV and TB. The pandemic makes this commitment even more urgent.

Innovative partnerships clearly remain essential to effectively address HIV and TB treatment supply during the pandemic but also provide key lessons in the global response to address COVID-19 itself.

Ending the silent epidemic of child and adolescent TB The COVID-19 pandemic is set to eliminate many years of progress against the HIV and TB epidemics. Children and adolescents are particularly vulnerable in the face of such a setback.

B

efore the pandemic hit, roughly a million children developed TB each year and a quarter of them died. Children with TB die from the disease at disproportionate rates.

They respond well to commonly used treatments, with less than 1% mortality among children who receive treatment.

However, of every 10 children who died from TB, nine of them had not accessed treatment and care.

WRITTEN BY

Dr Grania Brigden Director, Tuberculosis Department, The Union

the treatment of TB — as affirmed by precedents from national courts and international tribunals. These include the Committee on the Rights of the Child, the European Court of Human Rights (ECHR), and the African Court on Human and Peoples’ Rights.

We can prevent TB in children everywhere Preventive therapy is particularly important in children given their risk of developing TB disease if they Neglect of children with TB demands do not access preventive therapy. global attention Working with health authorities and The widespread neglect of children with community health workers in Uganda, TB constitutes a human rights violation The Union has proven that it is feasible that demands urgent to use clinical attention from symptoms to see the international if children, with or community. without HIV, are sick Children have with TB and then The widespread neglect every right to such provide them with of children with TB treatment. This appropriate care. right is enshrined The results are very constitutes a human in numerous positive. When we rights violation that international started, only 5% of legal frameworks, demands urgent attention children exposed including the to TB were getting from the international Convention on the preventive therapy. community.

Rights of the Child In just two years, it and the International increased from 5% Covenant on Economic, Social and to 74%. We tested a similar approach Cultural Rights. in West Africa and had similar results.

Over the last two decades, legal We continue to work with ministries activists have effectively used human of health to scale up these successful rights law to make healthcare provision approaches. more equitable, regardless of social, This World AIDS Day let’s look to the economic, ethnic, cultural, or other inspiring precedents set by the HIV/ special status. Unsurprisingly, many of AIDS community and redouble our the precedents concern HIV treatment, efforts to ensure that all children and reflecting the pioneering role of adolescents, everywhere, can realise activists in expanding access to care. their right to effective TB prevention, The same imperatives also compel treatment and care.

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BREAKING NEWS There is a hidden risk called Latent Tuberculosis Infection (LTBI).

TB is the leading cause of death among people living with HIV, causing more than one third of all AIDS-related deaths.1 10% of people with LTBI develop active TB during their lifetime, but for people living with HIV the risk is dramatically increased – from 80 to 110 times more!2 Adults and adolescents living with HIV should receive TB preventive treatment as part of a comprehensive package of HIV care.3 With the adoption of the WHO End TB Strategy in 2015, it’s critical to recognize the importance of scaling up LTBI management.

Expanding treatment of LTBI is essential to reach 2035 End TB targets4, committed to by Heads of State at the UNGA High Level Meeting in 2018.

TREAT HIV TREAT LTBI

MAT-GLB-2003473. 11.2020

Find more information at

1. UNAIDS Global HIV & AIDS statistics — 2020 fact sheet 2. Fox GJ et al. Preventive therapy for latent tuberculosis infection — the promise and the challenges. Int. Journal of Infectious Dis. 2017 Mar;56:68–76 3. WHO consolidated guidelines on tuberculosis. Module 1: prevention. Tuberculosis preventive treatment, 24.03.2020 4. World Health Organization. The END TB STRATEGY, 2015 // WHO - world health organization, UNGA- United Nations General Assembly.

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Testing, testing and more testing Over the last 40 years, HIV has killed millions and shattered lives. In many countries the death toll tragically continues to rise today. In England there’s the very real opportunity to be the first in the world to end new cases – why wouldn’t we grab it?

WRITTEN BY

Dame Inga Beale Chair, HIV Commission The Commission was established by leading HIV charities (Terrence Higgins Trust, National AIDS Trust and Elton John AIDS Foundation).

Ending HIV transmission in England It has been my privilege to learn this as Chair of the first ever HIV Commission. Just over a year ago my fellow commissioners and I were tasked with answering one rather daunting question: ‘How can we end HIV transmissions in England by 2030?’.

Now, on World AIDS Day, filled with passion and ambition, we’re setting out our vision.

Despite all the laudable progress made, England is not yet on track to meet the 2030 goal. That’s unacceptable when we have the necessary tools to ensure no one else

©UNAIDS

H

aving lived through the trauma HIV caused in the 1980s, I know there has been real progress in treatment and outcomes since then.

But I didn’t know the sheer extent of the progress. I didn’t know you can test at home and get a result within 15 minutes or there is a pill you can take daily to protect against HIV. I didn’t know a quarter of new HIV diagnoses every year in the UK are among women. I didn’t know that more than four in 10 people are still diagnosed late. I certainly didn’t know that effective treatment supresses the virus to such an extent that it can’t be passed on to partners.

Having lived through the trauma HIV caused in the 1980s, I know there has been real progress in treatment and outcomes since then. acquires HIV but are under-utilising them. Ultimately that’s what this is all about: the human cost of missing this target.

Increased testing within NHS The key message from our HIV Commission is testing, testing and more testing, in order to find the estimated 5,900 undiagnosed people living with HIV in England.

When you register with a GP, go to A&E or have blood taken anywhere in the NHS, there must be an offer of an optout, not opt-in, HIV test. Failure to make this change is a missed opportunity to diagnose every case of HIV. Maternity services show how transformative this approach to testing is, with near complete elimination of

babies being born with HIV. HIV testing is mainstream in maternity units, where midwives handle the associated issues with care and consideration and, critically, without judgement. The rest of the NHS must follow their example.

Now it’s over to government to ensure England consolidates its place as a leader in the fight against HIV. It must use our recommendations as a springboard for its own HIV action plan to see the country become the first in the world to end new cases by 2030.

In a year that’s often felt hopeless, what a message of hope that would be.

What is the HIV Commission?

The Commission was established by leading HIV charities and its 12 commissioners were tasked with reviewing all available evidence in order to make key recommendations for how to end HIV cases in England by 2030.

The Government has committed to reviewing these recommendations to informs its own HIV action plan. To read the full recommendations visit hivcommission.org.uk

Spend time with anyone from the Lupin Healthcare team and you will feel the pride in the partnerships we have developed.

Collaboration, teamwork and trust are the key to developing effective partnerships which stand out from the crowd and are pivotal to the continued success of our pursuit in delivering quality medicines and value to the patient and the NHS.

www.lupinhealthcare.co.uk Lupin Healthcare (UK) Limited, The Urban Building, 2nd Floor, 3-9 Albert Street, Slough, Berkshire, SL1 2BE, United Kingdom. Tel: +44 (0) 1565 751 378 LUP-CORP-009 Date of preparation: November 2020

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Investing in TB is critical to overcome HIV Tuberculosis (TB) is the world’s deadliest infectious disease, accounting for 1.4 million deaths globally in 2019. It is also the leading cause of death among those with HIV/AIDS.

INTERVIEW WITH

The Rt Hon The Lord Herbert of South Downs CBE PC Chair of the Global TB Caucus and Global Equality Caucus

Written by: TB Alliance

Paid for by TB Alliance

N

ick Herbert (Lord Herbert of South Downs), Chair of the Global TB Caucus and Global Equality Caucus discusses the impact of COVID-19, the TB and HIV pandemics and the need to invest in developing better tools to combat TB. What has the impact of COVID-19 been on people and communities already suffering from TB and HIV? The United Nations Sustainable Development Goals call for ending the TB and HIV/AIDS pandemics by 2030.

In spite of promising new advances, we were behind pace for these targets.

COVID-19 has knocked us further off track. A massive diversion of political attention and resources at the global, national, and operational levels has had serious impacts on programs to

Developing new tools has to be a partnership between the public and private sectors.

treat TB, HIV/AIDS, and other deadly diseases.

What is the role of research and development (R&D) in TB control? Why has the field been historically stagnant?

TB is largely a disease of the poor.

This means there are insufficient commercial incentives for companies to develop new tools for TB, such as a better vaccine, improved drugs and diagnostics. But these tools are essential; epidemics can’t be overcome without them.

If we can’t count on private industry alone to drive TB research, where will investment and innovation come from?

Everybody has a part to play. In a 2018 United Nations High Level meeting, countries agreed to increase funding for TB R&D to $2bn USD per year. Very few countries have met their target investment levels – the UK is one of the that few did. Investment in TB R&D has to be increased from all countries, not just the wealthiest ones.

Developing new tools has to be a partnership between the public and private sectors. Product Development Partnerships like the TB Alliance and

its recent six month regimen for highly drug-resistant TB are one example and will undoubtedly be key.

As we’ve seen from COVID-19, overcoming pandemics requires science, but also commitment of resources and political leadership.

What message does the Global TB Caucus have to world leaders about the urgency of investing in TB? We formed the Global TB Caucus to drive TB further up the political agenda. As we’ve seen from COVID-19, overcoming pandemics requires science, but also commitment of resources and political leadership. We call on parliamentarians to keep global health security atop your agendas, because deadly pandemics like TB and HIV/AIDS will persist even after COVID-19.

Read more at tballiance.org

The role of generics in HIV prevention Increased savings across the NHS through generic medicine supply has allowed government to start routine commissioning of essential HIV treatment and prevention medication.

D WRITTEN BY

Rhiannone Bahia Commercial Director Generics, UK, Lupin Healthcare UK

Paid for by Lupin

uring these economically challenging times the NHS needs to pursue financial savings in order to continue offering free healthcare to all UK citizens. Generic medicines can help achieve this.

A generic medicine contains the same active ingredient as the equivalent original branded drug, it is marketed once the originator’s patent protection has expired. Generic medicines deliver huge savings to the NHS with approximately 75% of prescriptions being fulfilled by generic medicines.1 Using generic medicines to prevent HIV In recent years, generic manufacturers have challenged originator patents within HIV, overturning such patents allows early generic entry which reduces the NHS spend by offering lower prices.

By adopting generic medicines in HIV management, the substantial savings made by the NHS has been used to make advances in HIV care and improve health outcomes. The NHS has been able to use these

savings to invest in initiatives such as the PrEP (pre-exposure prophylaxis) trial which allowed patients early access to a drug that protects against possible HIV infections.

On the 1st April 2020 the Secretary of State for Health & Social Care, Matt Hancock MP announced the start of routine commissioning of PrEP with an aim to eliminate new HIV infections within 10 years and end the HIV epidemic. Interventions such as PrEP will help contribute to the reduction in the HIV transmission rate in the UK. ‘‘We estimate that Lupin’s HIV medicine supply in the UK alone has saved over £200 million for the NHS over the last 3 years.2 This has meant Lupin have had to challenge patents and launch at risk to deliver such savings’’ commented Ben Ellis General Manager of Lupin Healthcare UK ‘‘we are tremendously proud of how the pharmaceutical industry along with the NHS have transformed the threat of HIV and AIDS for UK patients’’.

We estimate that Lupin’s HIV medicine supply in the UK alone has saved over £200 million for the NHS over the last 3 years.2 Focussing on delivering value and patient access Looking towards the future, it is important Lupin continues to develop and launch drugs that focus on delivering value and unmet patient need in the areas of HIV, neurology and respiratory. We will continue to fight for early entry in the generic sector where we believe we can increase further NHS savings.

References: 1.https://www.oxera.com/wp-content/uploads/2019/06/ Oxera-study-on-the-supply-of-generic-medicines -in-the-UK-26-June-2019.pdf 2. Data on File LUP-CORP-002 LUP-CORP-010 Date of preparation: November 20

Lupin Healthcare are part of the Indian based international pharmaceutical company Lupin Limited, who have a presence in 100 countries and are one of the biggest volume suppliers of medicines in the US and India. Lupin Healthcare are one of the largest volume suppliers of HIV drugs into the UK. Lupin Healthcare have sponsored and written this article.

lupinhealthcare.co.uk

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