PEPFAR Helps More Than 20 Million People With HIV Access ART Worldwide

In 2004, the US President’s Emergency Plan for AIDS Relief (PEPFAR) started providing HIV antiretroviral therapy (ART) worldwide. As of September 2022, the program has scaled up effective ART to reach more than 20 million individuals with HIV across 54 countries, according to the CDC’s latest Morbidity and Mortality Weekly Report.

PEPFAR was first announced in January 2003 and is the largest commitment by any single nation to address a single disease. With an overall aim to address health inequities in HIV treatment access, the program’s initial goal was to prevent 7 million HIV infections, treat 2 million people with HIV, and provide humane care for those suffering from AIDS and for children orphaned due to AIDS.

Between 2004 and 2022, the number of persons with HIV receiving PEPFAR-supported ART increased 300-fold, jumping from 66,550 persons to 20,166,110 persons less than 20 years later.

According to the report, most of these individuals received CDC-supported ART.

“Through PEPFAR, CDC is at the forefront of global ART scale-up efforts,” the report read. “CDC receives approximately 50% of PEPFAR funding for HIV treatment and supports approximately 60% of all persons receiving ART through PEPFAR.”

The report also showed that, between 2015 and 2022, the number of persons with HIV who received a viral load test annually increased 605%, from approximately 2.1 million to approximately 14.8 million. During this time, viral load coverage more than tripled from 24% to 80%, and viral load suppression—defined as <1,000 HIV copies per mL—increased from 80% to 95%.

Between 2017 and 2022, male and female individuals with HIV and individuals aged 20 years and older reached viral load suppression rates of ≥95% in 2022. By September 2022, viral load suppression rates among female sex workers, men who have sex with men (MSM), transgender persons, and persons who inject drugs reached ≥95%. Viral suppression rates among persons in prisons and other enclosed settings remained unchanged between 2020 and 2022 at 93%.

Population-based HIV Impact Assessment (PHIA) surveys were conducted in 6 African countries: Eswatini, Lesotho, Malawi, Uganda, Zambia, and Zimbabwe. The PHIA surveys showed that, since 2015, all 6 countries saw increased population viral load suppression rates, with overall rates ranging from 59.2% in Zambia to 73.1% Eswatini in the first survey, and ranging from 75.4% in Uganda to 88.6% in Eswatini in the second survey. Across all surveys, with few exceptions, population viral load suppression rates were higher among older individuals and women, compared with younger individuals and men.

In 2022, the PEPFAR-supported workforce included 371,760 total health care workers across approximately 70,000 community, clinic, or other health care settings. Between 2017 and 2022, the number of PEPFAR-supported facilities with a molecular laboratory increased by 115%, jumping from 926 to 1995. Additionally, the number of PEPFAR-supported facilities with one or more laboratory enrolled in a continuous quality improvement program increased by 112%, from 795 to 1687, and those that were accredited increased by 194%, from 103 in 2017, to 303 in 2022.

Despite these positive findings, 10 million people with HIV were not receiving ART in 2021, both in countries with and without support from PEPFAR. Globally, gaps in HIV care still exist and are worse for certain subpopulations, as demonstrated by the lower viral load coverage rates among younger children, men, pregnant women, MSM, transgender persons, and persons in prisons. Similarly, viral load suppression rates—despite reaching the UNAIDS target of 95% of persons with HIV infection receiving ART—were lower among pregnant and breastfeeding women and persons in prisons, and much lower for individuals aged younger than 20 years.

Additionally, with stigma and discrimination being important barriers to health equity, understanding the root causes of these observed differences in ART access and addressing potential factors leading to disparities is essential.

“To eliminate HIV as a global public health threat, achievements must be sustained and expanded to reach all subpopulations,” the report said. “CDC and PEPFAR remain committed to tackling HIV while strengthening public health systems and global health security.”

Reference

Chun HM, Dirlikov E, Cox MH, et al. Vital Signs: Progress toward eliminating HIV as a global public health threat through scale-up of antiretroviral therapy and health system strengthening supported by the U.S. president’s emergency plan for AIDS relief — worldwide, 2004–2022. MMWR Morb Mortal Wkly Rep. Published online March 14, 2023. doi:10.15585/mmwr.mm7212e1