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 unless countries take precautions and "put the last first". We argue that primary health care and public health approaches, with multi-sectoral actions and community engagement, are vital to minimize inequity, achieve UHC and leave no one behind.

中文翻译：

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不让任何人掉队：实施全民艾滋病毒治疗和全民健康覆盖政策的经验教训。

背景 第三个可持续发展目标（SDG-3）旨在确保各年龄段所有人的健康生活并促进福祉。SDG-3 有一个关于全民健康覆盖 (UHC) 的具体目标，强调所有人和社区在不面临经济困难的情况下获得优质卫生服务的重要性。本研究的目的是以抗逆转录病毒治疗 (ART) 作为案例研究，回顾全民健康覆盖的进展。方法我们使用了混合方法设计，包括定性和定量方法。我们回顾并综合了 2002 年至 2019 年间世界卫生组织艾滋病毒治疗指南演变的证据。我们按性别、年龄组和地点计算了一段时间内的 ART 覆盖率。我们还估计了 ART 覆盖率的差异和比率。调查结果 艺术指南已经从“治疗病情最严重的人”演变为“治疗所有人”。全球抗逆转录病毒治疗覆盖率从 2005 年的不到 7% 增加到 2018 年的 62%。在提高所有人群和地点的抗逆转录病毒治疗覆盖率方面都取得了成功。然而，许多地区的进展情况因人口和地点而异。ART 覆盖率存在不平等：女性（68%）与男性（55%）、成人（62%）与儿童（54%）。随着时间的推移以及 ART 资格标准的扩大，这种不平等现象不断扩大。另一方面，至少一个高负担国家（埃塞俄比亚）的数据显示，由于该国初级卫生保健系统的改善和公共卫生方法的实施，地区之间的不平等随着时间的推移而缩小。结论 在全球、区域和国家层面，所有人口群体的抗逆转录病毒治疗覆盖率均有所提高。然而，不同地点和不同人群所取得的成果并不公平。除非各国采取预防措施并“优先考虑”，否则实现普遍性的政策可能会扩大资源有限环境中的不平等。我们认为，初级卫生保健和公共卫生方法以及多部门行动和社区参与对于最大限度地减少不平等、实现全民健康覆盖和不让任何人掉队至关重要。