West and Central Africa - No time to lose: overcoming barriers to acceleration of HIV treatment

The Western and Central Africa (WCA) region is home to 18% of the total number of people living with HIV, with 22% of new infections in the overall population and 43% of new infections among children worldwide. In 2015, the number of deaths linked to HIV in WCA contributed to an estimated 30% of all HIV-related deaths worldwide.

However, the region is significantly lagging behind on each level of the HIV treatment cascade. In 2015, only 36% of people living with HIV (PLHIV) knew their HIV status in WCA, compared to 62% in Eastern and Southern Africa (ESA), and 60% globally. Antiretroviral therapy (ART) coverage was estimated at 28%, compared to 54% in ESA, leaving 4.7 million PLWHIV without treatment. ART coverage was even lower for children, with 20% in WCA compared to 45% in ESA. In 2015, the number of new HIV infections (estimated at 410,000) was higher than the number of patients who had recently started receiving ART treatment (estimated at 240,200). Availability of viral load measurement remains very limited in WCA countries. In 2015, only 12% of patients receiving ART had a test confirming they had an undetectable viral load, compared to 45% in ESA. 

Key obstacles to scaling up treatment and access to services include policy, system and financial barriers. Such as, over-medicalisation and centralisation of services, weak and dysfunctional supply chains, insurmountable financial barriers, strong stigma against PLHIV, funding shortfalls for acceleration plans for most countries in the region, and limited support to civil society.

In order to remove such barriers, commitment of governments and technical and financial partners is essential. Actions include; implement WHO’s “Treat All” recommendation in the region’s 25 countries, implement a “free of charge” policy for all elements of HIV and TB care for PLHIV, adopt and implement differentiated ART access models as national policy, improve in-country supply chains, actively involve civil society and PLHIV associations and combine national commitments and international funding.