Antiretroviral therapy (ART) coverage among all age groups
Since 2000 the global total of people receiving ART double every three to four years, which was caused by affordable ART, an increase in generic competition and the establishment of new funding. In 2000 only 690 000 of the estimated 28.6 million
[26.4-31.2 million] people living with HIV received ART, in 2014 it reached 14.9 million people of the estimated 36.9 million [34.3-41.1 million] people living with HIV. This shows that the global coverage of ART increased from 2% of people living with HIV in 2000 to 40% in 2014. This progress was further consolidated so that 15.8 million people received ART in mid-2015. Thereby the MDG for 2015 –to bring 15 million people on treatment– was reached as a great public health achievement of recent times. The next challenge is to accelerate the treatment access so that ART is available to all people living with HIV, in accordance with the new guidelines (WHO: Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV, September 2015*).
In the WHO African Region, 41% [38–46%] of people living with HIV were able to access life-saving medicines in 2014. Similarly, 46% [40–55%] in the Region of the Americas, 9% [6–13%] in the Eastern Mediterranean Region, 19% [17–22%] in the European Region, 36% [33-38%] in the South-East Asia Region and 37% [30–49%] in the Western Pacific Region were accessing such treatment. It is increasingly clear that everyone infected with HIV will need treatment in accordance with the new WHO guidelines (2015) for offering treatment for all people with HIV. In addition, the use of daily oral pre-exposure prophylaxis is recommended as prevention for people at substantial risk of HIV. The benefits of ART – both at the individual and population levels - are optimized when people living with HIV start treatment early.
With an estimated 34.4 [32.0–38.6] million people now living with HIV in low- and middle-income countries, this represents a significant need to scale up HIV testing and treatment, while continuing to invest in prevention and other programmes to combat new infections.
Among the countries with the largest numbers of people on ART in 2014 were South Africa (23% of all people on ART in low- and middle-income countries were in this country), India (6%), Zimbabwe (6%), Kenya (6%) and Nigeria (6%).
Overall antiretroviral therapy coverage among children was lower than among adults in low- and middle-income countries. ART coverage in 2014 was 32% [30-34%] for children, compared with 41% [38-46%] for adults. In 2013 WHO recommended to initiate ART in all HIV-positive children under 5 years irrespective of their immune status. As of July 2015, 40% of low-and middle-income countries adopted such policy. Children represented 5.5% of the people receiving antiretroviral therapy and approximately 10% of the people living with HIV. The number of children younger than 15 years who received ART expanded from an estimated 18 000 in 2000 to 824 000 in 2014, and more than doubled between 2010 and 2014. The increase is due chiefly to progress in African Region, which is home to over 90% of children with HIV.
Access to ART has increased rapidly in low- and middle-income countries since 2003 from just 400 000 to 13.6 million by end of 2014. The estimated ART coverage in low- and middle-income countries increased from 35% in 2013 to 40% in 2014. The greatest increase occurred in sub-Saharan Africa, where ART was uncommon up to 2003 (100 000 people on ART) and increased over 100-fold to 10.6 million in 2014. Regions that have made less progress are those in which the epidemic is predominantly concentrated in populations with lower access and utilization of services, such as sex workers, injecting drug users, and men who have sex with men.
Globally, there were 15.8 million people receiving ART in mid-2015.