Towards Universal Access’€, a progress report on the health sector’€™s response to the HIV epidemic worldwide found that 20 countries accounted for over 83% of the total number of patients receiving ARV therapy in low and middle-income countries in 2009, most of them in sub-Saharan Africa.

The report by the World Health Organisation, the United Nations Children’s Fund, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) was released in Nairobi yesterday.

At the end of 2009, 5 254 000 people were receiving ARV therapy in low- and middle-income countries, an increase representing a 30% rise from a year earlier and a 13-fold increase in six years.

However, only 28% of all children in need of ARV therapy accessed the drugs.

Home to the greatest absolute number of people living with HIV ‘€“ 5,7-million – South Africa now provides ARV therapy to 18% of all patients treated worldwide.

Zimbabwe recorded the highest increase in enrolment, where the number of people on treatment increased by almost 50% between December 2008 and December 2009.

Despite continued progress, however, treatment in many of these countries remained well below the estimated needs, the report said.

WHO’€™s recommendation to change the CD4 cell count threshold for initiation of ARV therapy from 200 to 350 increased by 45% the number of people estimated to be in need of ARV therapy in low- and middle-income countries in 2009, from 10,1 million to 14,6 million.

‘€œWhile such an expansion in the number of eligible patients may increase the initial investments required to provide universal access to antiretroviral therapy in resource-limited settings, this expense is likely to be compensated for in the medium term by savings related to fewer hospitalisations, and lower morbidity and mortality rates. The effect of antiretroviral therapy on reducing HIV transmission may also improve the economic advantages of expanding access to antiretroviral therapy,’€ the report said.

It highlighted a recent study in South Africa which estimated that while adopting the revised criteria for treatment initiation would imply an immediate increase in investment needs, these would be fully offset by savings by 2014 and, over five years, overall programme costs would actually drop by about U$470-million.

However, the report cautioned that while access was increasing, it masked the unseen mortality of those who die before they are initiated on treatment despite being deemed eligible. Patients who tested HIV-positive and enrolled in HIV care may not all start ARV therapy or, more worryingly, may start late after reaching eligibility levels.

In South Africa, among 44 844 patients enrolled in care between May 2004 and December 2007, 22 083 were or became eligible for antiretroviral therapy. However, while 68% of them were receiving ARVs after two years, 26% had died before starting treatment and 6% were alive and untreated.

Sub-Saharan Africa also continues to account for the majority of people living with HIV and TB in the world. In 2008, around 78% of estimated HIV-positive TB cases were in this region, of which around one quarter was living in South Africa.

However, the report did share some good news. Four countries ‘€“ Botswana, Namibia, Swaziland and South Africa (the country with the largest number of pregnant women living with HIV) ‘€“ have already reached the target set at the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS of providing 80% of pregnant women in need with ARVs for reducing the risk of mother-to-child transmission of HIV.