As Obama’s new global AIDS coordinator, Dr. Eric Goosby has no shortage of burning issues on his plate—from reports of ARV stock-outs in the developing world to questions about the long-term sustainability of PEPFAR. At a 1 ½ hour community meeting at the State Department Friday, the unassuming California doctor tried to reassure the global AIDS community that he has his eye on both the immediate and the far-reaching.
So even as he’s pushing aggressively forward to develop country ownership and building capacity for taking over AIDS programs, Dr. Goosby said he’s also urgently aware of the need to scale up prevention of mother to child transmission, to find ways to expand ARV treatment in a tight budget climate, and to meet new PEPFAR mandates, including recruiting 140,000 new health care workers.
In a wide-ranging session with more than 100 advocates and experts, Dr. Goosby said his overarching goal as head of PEPFAR is to build an enduring program that will be there to serve the sick and poor in developing nations for decades. “We are at an exciting point in PEPFAR’s evolution,” he said from the dais of an auditorium in the State Department. “Our charge now is to make sure that contribution is realized into the future, not for five years but for 25.”
“… The economic downturn has created an urgency to this discussion that wasn’t there before,” Dr. Goosby said. But he acknowledged the country-ownership effort will take a decade or longer to achieve.
“No country is in a position to take over” these PEPFAR programs, but US and other leaders need to start the dialogue now, he said.
Dr. Goosby began the Friday meeting with brief opening remarks, delivered in his characteristic soft-spoken style. He then opened it up to questions from the audience, and the first one was pointed. Several activists read from an open letter to Dr. Goosby that took him to task for a recent statement suggesting that the targeted goal of universal access to ARVs in South Africa by 2015 was not realistic.
Goosby responded by saying that PEPFAR was “committed to universal access and doing what will be hard work to achieve that.” At the same time, he questioned whether the U.S. would have the resources to make that happen and added: “As the person sitting in this chair, I feel an urgent responsibility to diversify the approach to maintaining this program for 25 years.”
That’s why, he said, “we are aggressively” talking with other donor nations about how to make the fight against global AIDS “real and lasting.”
On another hot topic–changing the CD4 count at which ARV treatment is initiated–Goosby said the science is clear, but the way forward is not. “We expect the number of eligible patients will rise up to two to four times … and will give us another stress on the system for cost and meeting those needs,” he said.
“Countries will decide if they’re going to embrace it and if so, how they will find the resources,” he said, adding that PEPFAR was working on a process for multilateral and country discussions about the issue.
Asked about new program directives that reflect more evidenced-based prevention policies, Dr. Goosby said that OGAC would likely provide a “menu of options” to countries and let them make those decisions locally. He also said “we are clear” about the need for needle exchange programs and said he did not think it would be long before such programs were available.
He also talked about the administration’s much-anticipated Global Health Initiative. Internal deliberations over the details of that plan are ramping up, he said, and HIV/AIDS is a “a critical and inherent central piece” of that proposal. But there’s also a desire to move provide more vertical integrated health aid, and to focus intensely on services to women, and PEPFAR will be retooled to reflect that.
Goosby said, for example, that a woman who seeks care at a PEPFAR clinic might also get reproductive health care services, with PEPFAR resources, if those would not be otherwise available to her.
“The Secretary has set priorities with an eye on women, and to me, that’s a no-brainer,” Goosby said.