Jamieson David, Kellerman Scott E
Partnership for Supply Chain Management (PFSCM), Arlington, VA, USA;
Partnership for Supply Chain Management (PFSCM), Arlington, VA, USA.
J Int AIDS Soc. 2016 Jun 30;19(1):20917. doi: 10.7448/IAS.19.1.20917. eCollection 2016.
UNAIDS "90-90-90" strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. Reaching these targets by 2020 will reduce the HIV epidemic to a low-level endemic disease by 2030. However, moving the global response towards this universal test and treat model will pose huge challenges to public health systems in resource-limited settings, including global and local supply chain systems. These challenges are especially acute in Africa, which accounts for over 70% of the persons affected by HIV.
From a supply chain perspective, each of the "90's" has possible complications and roadblocks towards realizing the promise envisioned by 90-90-90. For instance, ensuring that 90% of HIV-infected persons know their status will require a large increase in access to HIV tests compared with what is currently available. To ensure that there are enough anti-retrovirals available to treat the nearly 25 million people that will require them by 2020 represents a near doubling of the ARV supplied to treat the 13 million currently on treatment. Similarly, to monitor those on treatment means an unprecedented scale-up of viral load testing throughout Africa.
Larger issues include whether the capacity exists at the local level to handle these commodities when they arrive in the most severely affected countries, including considerations of the human resources and costs needed to make this strategy effective. We believe that such "real world" analysis of proposed strategies and policies is essential to ensure their most effective implementation.
联合国艾滋病规划署的“90-90-90”战略要求到2020年，90%的艾滋病毒感染者得到诊断，其中90%将接受抗逆转录病毒治疗（ART），且90%将实现病毒学持续抑制。到2020年实现这些目标将使艾滋病毒流行在2030年降至低水平地方病。然而，将全球应对措施转向这种普遍检测和治疗模式将给资源有限地区的公共卫生系统带来巨大挑战，包括全球和地方供应链系统。这些挑战在非洲尤为严峻，非洲艾滋病毒感染者占全球的70%以上。
从供应链角度来看，“90”中的每一项在实现“90-90-90”所设想的前景方面都可能存在并发症和障碍。例如，要确保90%的艾滋病毒感染者知晓自身感染状况，与目前的检测机会相比，检测机会需要大幅增加。要确保到2020年有足够的抗逆转录病毒药物来治疗近2500万人，这意味着用于治疗目前1300万正在接受治疗患者的抗逆转录病毒药物供应量几乎要翻倍。同样，监测接受治疗的患者意味着要在整个非洲前所未有的扩大病毒载量检测规模。
更大的问题包括，当这些药品抵达受影响最严重的国家时，当地是否有能力处理这些药品，包括对使该战略有效实施所需的人力资源和成本的考量。我们认为，对拟议战略和政策进行这种“现实世界”分析对于确保其最有效实施至关重要。
