Leaving no one behind: lessons from implementation of policies for universal HIV treatment to universal health coverage

Abstract

Background The third Sustainable Development Goal (SDG-3) aims to ensure healthy lives and promote well-being for all at all ages. SDG-3 has a specific target on universal health coverage (UHC), which emphasizes the importance of all people and communities having access to quality health services without risking financial hardship. The objective of this study is to review progress towards UHC using antiretroviral treatment (ART) as a case study.Methods We used a mixed-methods design including qualitative and quantitative approaches. We reviewed and synthesised the evidence on the evolution of the WHO HIV treatment guidelines between 2002 and 2019. We calculated ART coverage over time by gender, age group, and location. We also estimated ART coverage differences and ratios.Findings ART guidelines have evolved from “treating the sickest” to “treating all”. ART coverage increased globally from under 7% in 2005 to 62% in 2018. There have been successes in increasing ART coverage in all populations and locations. However, progress varies by population and location in many regions. There is inequity in ART coverage: women (68%) versus men (55%), and adults (62%) versus children (54%). This inequity has widened over time, and with expanded ART eligibility criteria. On the other hand, data from at least one high-burden country (Ethiopia) shows that inequity among regions has narrowed over time due to the improvements in the primary health care systems and implementation of the public health approach in the country.Conclusion ART coverage has increased at global, regional and national levels to all population groups. However, the gains have not been equitable among locations and populations. Policies towards universality may widen the inequity in resource-limited settings. We argue that primary health care and public health approaches, with multi-sectoral actions, are vital to minimize inequity and achieve UHC.

Effectiveness of same-day antiretroviral therapy initiation in retention outcomes among people living with human immunodeficiency virus in Ethiopia: empirical evidence

“…Despite a suboptimal retention rate and early program losses that have followed the scale-up of universal “test and treat” program especially same-day initiation, evidence showed an increased trend in implementation of rapid ART initiation in LIS [ 21 , 22 , 25 ]. While the push to meet the fast-tracked UNAIDS targets [ 43 ] has increased access to early treatment of PLHIV [ 44 ], the need for adequate preparation and readiness assessment of PLHIV is becoming evident. We echo the recommendation of Geng and Havlir [ 45 ] that the science of rapid ART should pay attention to the “how” part of treatment initiation since the effect of same-day treatment can be altered by patient, provider and system-level factors.…”

‘… The Elderly are More Comfortable at Home Than at The Health Facility’. Primary Care Provider Notions On Instituting Community-Based Geriatric Support in Uganda

“…Ageing comes with unique economic [3,4] physical, psychological, and health vulnerabilities [5][6][7][8]. This, in line with the Universal Health Coverage's "leave no one behind" agenda calls for government efforts to design quality, accessible, and equitable promotive, preventive, curative, rehabilitative and palliative health services [9] that effectively and e ciently meet the needs of old adults, at every level of development, if we are to achieve sustainable development goal three. For this, health systems in the developing world should be investing and researching on the best models for providing geriatric support to this growing population.…”