AHF questions UNAIDS estimate of 18.2 million people on treatment, says “Estimation without Validation” hurts the AIDS response

LOS ANGELES (November 22, 2016) – AHF called into question the validity of the latest UNAIDS estimate released on Nov. 21, which puts the number of people on antiretroviral therapy (ART) globally at 18.2 million as of June 2016.[1] The new revelation comes only six months following the release of the previous estimate of 17 million people on ART as of the end of 2015.[2]

 

AHF’s doubts about the accuracy of the data have been aroused by the rapidly increasing reported number of people on treatment at a time when there are no mechanisms in place to independently verify UNAIDS estimates.

 

“Under the current framework of ‘90-90-90’ targets there is an inherent conflict of interest for UNAIDS. After UNAIDS heavily promoted and popularized ‘90-90-90,’ the strategy has been adopted by many governments and civil society organizations,” said Michael Weinstein, AHF President. “Now UNAIDS is under political pressure to ensure that ‘90-90-90’ is a success. This means having 30 million people on treatment by 2020 as part of the second ‘90’ in the ‘90-90-90.’[3] In light of the current state of global AIDS funding, which has declined by a billion dollars for the first time since 2010,[4] this is a laudable but not realistic goal. Instead of acknowledging this fact, UNAIDS is stretching their estimates to fit their own targets.”

 

The concerns are further compounded by the findings of the Group on Burden of Disease (GDB) which were published in The Lancet journal earlier this year.[5] The GDB report stated that, with respect to treatment coverage rates collated by UNAIDS, there needs to be stricter adherence to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER), which were developed by the WHO. Some estimates done by the GDB differed by a large margin from those done by UNAIDS. GDB also pointed out that verification of data which UNAIDS collects from countries that closely guard their epidemiological statistics, such as China, Russia and India, is challenging.

 

As one of the largest non-governmental providers of direct HIV care to 645,000 clients in 36 countries, AHF has extensive experience in auditing patient rolls for accuracy. When AHF is invited to assume operations for a struggling government program, it is not unusual to find that the number of people reported as being on ART is inflated by up to 30 percent.

 

In many instances government programs simply do not have the human resources to routinely update their data for patients who have been lost to follow up or have died, consequently the number of people on treatment reported to UNAIDS in a given year more often approximates the number of people who have ever started treatment, irrespective of whether they are still in care.

 

AHF has been communicating its concerns about the validity of UNAIDS treatment estimates since 2015

in correspondence with Dr. Peter Ghys, Director of Strategic Information and Evaluation Department at UNAIDS. Despite numerous letters, to date UNAIDS headquarters has not acknowledged that the estimates might be inflated. The correspondence is being released in its entirety as part of this statement, it can be viewed here: https://goo.gl/5H1r4I.

 

“UNAIDS’s treatment estimates keep lurching forward at a breakneck speed. The number has gone up by 4.6 million since the end of 2014, but what we hear on the ground does not correlate to the alternate reality UNAIDS is creating with its ‘policy by press releases’ approach,” said Dr. Penny Iutung Amor, AHF Africa Bureau Chief. “Pharmaceutical distributors are scratching their heads in some of the countries where we work, they say ‘we see the growing treatment numbers, but we don’t see the corresponding procurement volumes.’”

 

“Same goes for testing. Where is the massive scale-up of testing needed to identify millions of positive people? Pumping up numbers that cannot be verified is detrimental to the war on AIDS and is immoral,” added Dr. Iutung Amor. “These aren’t just numbers, these are human lives. We call on UNAIDS to urgently undertake a comprehensive audit of the treatment numbers and make disaggregated data and estimation methodology publically available for independent review.”

 

 

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[1] https://goo.gl/k4dchW

[2] https://goo.gl/1BnjpG

[3] https://goo.gl/yVwLcC

[4] https://goo.gl/4xtQua

[5] https://goo.gl/RMyWJ8

AIDS Healthcare Foundation (AHF), the largest global AIDS organization, currently provides medical care and/or services to over 645,000 clients in 36 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region and Eastern Europe. To learn more about AHF, please visit our website: www.aidshealth.org, find us on Facebook: www.facebook.com/aidshealth and follow us on Twitter: @aidshealthcare and Instagram: @aidshealthcare