Efforts to end HIV, hepatitis and STIs were off track even before pandemic, report finds
Efforts to end HIV, viral hepatitis and STIs by 2030 were off track even before the COVID-19 pandemic struck, according to a new report.
The report, published Thursday by WHO, highlighted achievements and gaps in strategies to address HIV, viral hepatitis and STIs between 2016 and 2021. It says “time is running short” to eliminate these public health threats by 2030, calling that goal “enormous yet feasible.”
“Some of these gaps have been widened by the COVID-19 pandemic, but even before this crisis, we were not on track to reach our elimination targets by 2030. We must redouble our efforts to maintain and strengthen essential health services,” WHO Director General Tedros Adhanom Ghebreyesus, PhD, MSc, said during a press briefing.
“Together, we much harness the same urgency and determination with which we have fought the COVID-19 pandemic to reduce the global burden of HIV, vital hepatis and STIs and build a healthier, safer, farer future,” Tedros said.
According to the report, HIV, viral hepatitis and STIs account for more than 2.3 million deaths globally each year — 14% of all deaths from infectious and parasitic diseases — and 1.2 million cases of cancer. More than 1 million people are newly infected each day.
“The past year has been dominated by the challenges of the COVID-19 pandemic, which has resulted in disruptions to the public health sector,” Ren Minghui, MD, MPH, PHD, WHO assistant director-general for HIV/AIDS, tuberculosis, malaria and neglected tropical diseases, said during the briefing.
Minghui said the global response to the pandemic has demonstrated people’s resilience and the ability to innovate to maintain essential services during a crisis.
“This is an important year to take stock of the progress achieved in addressing disease today and setbacks caused by the pandemic. This is learning for the next decade,” he said.
Nine-fold increase in HCV treatment
According to the new report, hepatitis B and C caused 3 million new infections and 1.1 million deaths in 2019. Breaking down the data further by hepatitis type, it revealed that only 10% of people who have chronic HBV are diagnosed, and only 22% of those diagnosed received treatment, whereas only 21% of those with chronic HCV infection are diagnosed, 62% of whom receive treatment.
A recently published study reported disruption to HCV care in the United States, including a 59% decrease in HCV antibody testing volume during April 2020, which rebounded to a 6% reduction in July. Additionally, the number of HCV RNA-positive results fell by 62% in March 2020 and remained 39% below the baseline by July 2020, and prescriptions for HCV treatments decreased 43% in May, 37% in June and 38% July, relative to the corresponding months in 2018 and 2019.
Despite disruptions, there have been some successes regarding hepatitis incidence. According to the report, a reduction in the incidence of HBV infection is one of the few Sustainable Development Goals targets that is on track. Additionally, new data showed that 9.4 million people are receiving treatment for chronic HCV infection, which WHO said is a more than ninefold increase since 2015.
Lowest annual HIV incidence since 1990
According to the report, HIV incidence is the lowest it has been since 1990, with 1.7 million people newly infected in 2019. However, this remains “far below” the global target of less than 500,000 people newly infected by 2020, WHO noted.
According to data from the report, there has been a large-scale expansion of HIV treatment, as well as a reduction in mother-to-child transmission of syphilis and HIV.
Additionally, approximately two-thirds of all people living with HIV and 85% of pregnant women living with HIV are receiving ART, leading to a “substantial decline” in mortality and fewer pediatric infections from vertical transmission, the report found.
Global STI incidence plateaus
STIs have been an ongoing and growing problem both globally and in the U.S.
The most recent data from the CDC showed that 2.5 million cases of gonorrhea, syphilis and chlamydia were reported in the U.S. in 2019, the sixth straight year of record-breaking STI cases. Case counts for 2020 have not been released, but projections show that reported cases of chlamydia, gonorrhea and syphilis dipped below projections for 2020 in the U.S., likely due to shifts in resources, declines in testing because of clinic closures related to the pandemic and “sexual distancing” caused by stay-at-home orders.
According to the WHO report, globally, there are 374 million new cases of four curable STIs each year: 156 million cases of trichomoniasis, 128 cases of chlamydia, 82 million cases of gonorrhea, and 7 million cases of syphilis. The incidence of most STIs has plateaued except for congenital syphilis, which has shown slow declines over recent years, although not in the U.S.
The report included some good news about STIs, including that many more countries now have national strategic plans and updated guidelines to address them, all while interventions such as syphilis screening of pregnant women in antenatal care and human papillomavirus vaccination are increasing.
Minghui said that, overall, there has been “very impressive progress” in many areas of response to hepatitis, HIV and STIs, including large-scale expansion of HIV treatment, innovations in direct-acting antiviral treatments, the emergence of a cure for HCV and increasing coverage of immunizations for HBV. However, one challenge is that many people are unable to access these vital interventions, WHO noted. It said the populations most severely affected and at higher risk young people and those stigmatized by these diseases are missing out on services.
WHO. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. https://www.who.int/publications/i/item/9789240027077. Accessed on May 20, 2021.
WHO. New report highlights global progress on reducing HIV, viral hepatitis and sexually transmitted infections and signals need for renewed efforts to reach 2030 targets. https://www.who.int/news/item/20-05-2021-new-report-highlights-global-progress-on-reducing-hiv-viral-hepatitis-and-sexually-transmitted-infections-and-signals-need-for-renewed-efforts-to-reach-2030-targets. Accessed on May 20,2021.