What it takes to end AIDS, TB and malaria by 2030
By Tawanda Chisango
African leaders have set 2030 as the time frame to end AIDS, TB and malaria. Sustained leadership on the African continent to ensure diversified financing, access to affordable and quality assured medicines, sound governance and accountability is the key to ending AIDS, TB and malaria epidemics. The African leadership has demonstrated sustained leadership on these three biggest diseases on the continent beginning with the 2000 and 2001 Abuja Declarations. These have been followed by renewed commitments that include the 2006 Abuja Call and the 2013 Abuja Declaration to intensify ongoing efforts. The AU Roadmap on Shared Responsibility and Global Solidarity and the Pharmaceutical Manufacturing Plan for Africa has produced excellent results.
Significant progress has been achieved
The impact of Africa’s leadership and its commitment to global solidarity in the case of HIV has been significant. In less than a decade, access to HIV treatment in Africa increased more than 100-fold. Approximately 10 million people are now on treatment, new HIV infections in Africa’s South of the Sahara declined by 33%. AIDS-related deaths in the same region has declined by 30%.
Similarly, increased political commitment and expanded funding have helped to reduce malaria incidence by 31% in Africa. As a result, an estimated 337 million malaria cases and 3 million deaths were averted in Africa. Malaria mortality rates have declined by 54% overall and by 58% among children. Additionally, the picture of the TB epidemic is shifting positively with Africa’s TB treatment success rate reaching 82% in 2012.
How to surmount key challenges to end AIDS, TB and malaria
But despite historic gains, these epidemics are far from over. AIDS remains a leading cause of death in Africa, killing 1.1 million people on the continent in 2013, with an estimated 1.5 million new HIV infections. An African child still dies almost every minute from malaria. Approximately USD1 billion is required to cover the malaria funding gap by end of 2015 and the TB response will need to reach about 1.3 million people in Africa.
The fact remains that health funding in most African countries is below what is required to achieve a functional, basic health system, and to end these diseases. This funding crisis calls for accelerated innovative domestic financing that includes shifting existing budgets toward spending on the diseases, considering an alcohol or airline levy, new initiatives to diversity funding sources like boosting private sector commitments, increased global partnership and solidarity to ensure these needs are met. As Africa finalizes its long term developmental framework, Agenda 2063, Africa should tap into its huge economic growth to finance health. It should continue to push forward, collaborate, and innovate to defeat the continent’s biggest health issues.
African experts have already started work on catalytic actions to end AIDS, TB and Malaria by 2030 that will be considered at the AU 2016 Summit. Some of the key actions include addressing human resources for health, strengthening health information systems and research, increasing financing for AIDS, TB and malaria to ensure that responses are sustainable and predictable, fast tracking access to medicines, diagnostics and harmonization of regulatory systems. There are plans to have a single medicine regulatory agency by 2018.
Experts have further recommended the need to put in place an accountability framework and mandated the AU and Member States to develop indicators and scorecard to monitor uptake and implementation of high level declarations at country level. Investing in demand creation, community empowerment, understanding and addressing vulnerabilities are critical success factors. Some other areas that shouldn’t be neglected include socio-cultural drivers of the epidemic and the strengthening of existing / traditional family and leadership structures, basically because these factors are equally critical success factors.
Fully funding the Global Fund to Fight AIDS, TB and malaria must remain a key global priority in mounting an effective response to the three diseases.
Ending AIDS by 2030
For the AIDS epidemic, Africa should leverage on existing strategies such as the Global Plan and Fast-Track Strategy for Ending AIDS. The continent should continue to conduct the Know Your Epidemic/ Know Your Response studies, fully implement combination prevention strategies and ensure that eMTCT remains a priority.
The continent should ensure that programmes are in place that target those that contribute to the high numbers of new infections – this includes addressing eMTCT and strengthening programming for mothers, children, youth, young women, girls and key populations. There is need to create an enabling legal environment that promotes access to preventing and addressing legal barriers that hinder access. There is need to prioritize access for treatment for children and adolescents. About 90% of all children living with HIV are in Africa’s south of the Sahara, with only 23% accessing treatment, as a result of this, AIDS-related deaths are increasing in adolescents compared to other populations where AIDS-related deaths are declining.
Defeating Tuberculosis by 2030
Africa‘s TB treatment success rate reaching 86% in 2013. In 2013 the case detection rate had slightly improved at 52%. Africa outpaced other regions in determining the HIV status of all people with TB. Africa is the only continent not on track to achieve the Millennium Development Goals. The continent will need to strengthen TB diagnosis, treatment and TB-HIV collaborative activities. Africa should also take drastic measures to reduce the incidence of drug resistant TB and intensify advocacy for the TB epidemic to attract more funding especially from government sources. There is further need to strengthen TB diagnosis in children, address structural determinants of HIV/TB co-infections and intensify efforts towards vaccine development.
Eliminating malaria by 2030
The focus for malaria should be on maintaining or scaling-up universal coverage of key priority interventions for malaria. Key actions include committing adequate funding for and uninterrupted supply of live-saving malaria commodities.
One of the key priorities for eliminating malaria is to ensure that there is effective monitoring of effective insecticide use including research and development on alternative insecticides. African countries should implement the WHO T3 initiative by ensuring universal access to diagnostic, testing for all suspected malaria cases and quality-assured anti-malaria treatment for confirmed infections and tracking the diseases through timely and accurate surveillance.
To consolidate the progress already made the African Union Commission is working with the New Partnership for Africa’s Development (NEPAD) in consultation with Member States and development partners to develop a catalytic framework detailing milestones towards ending the epidemics of AIDS, TB and malaria in line with the Abuja +12, 2030 target.
Tawanda Chisango is the AIDS Watch Africa Programme Advocacy and Partnerships Expert