HIV Scale-up and Synergies

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Wafaa El-Sadr, Director of the International Center for AIDS Care and Treatment Programs (ICAP); Professor of Medicine and Epidemiology at Mailman School of Public Health, Columbia University, shared her own experience on scaling up HIV programs based on her work in Africa. She focused on the importance of integrating HIV treatment with other health interventions.

She suggested that HIV scale-up had provided the first  chronic disease service delivery model in the developing world.  This chronic disease model responds to a disease that affects individuals and families throughout the life cycle with infected individuals experiences periods of acute illness, living with chronic symptoms but enjoying periods of relatively good health as well.  There are multiple clinical and psychosocial needs with support needed for adherence to treatment regimens and retention in care.  HIV care delivery has emphasized linkage and integration with maternal and child health services and TB care and treatment while pioneering a system of patient-centered care not seen in these settings before.

Bottom line – it is misleading to talk about HIV scale-up as a vertical program with no impact of broader health systems and no added value to the community at large.

Before ARV roll-out in the developing world, the AIDS epidemic was overloading hospitals and putting healthcare system in crisis. But access to HIV treatment has helped alleviate that. “There is a remarkable impact from [efforts to] scale up” HIV treatment and prevention, said El-Sadr.  She said scaling up involves integrating a number of activities, including improving health service delivery, financing, disseminating and developing medical products and technology, training the health care workforce, and effectively educating and informing the public .

El-Sadr cited two ways of thinking about achieving the 8 Millennium Development Goals (MDGs) (LINK)

  1. Investment in Health Systems
  2. Investment in HIV programs

But these are not mutually exclusive. There can be investment in HIV programs with a focus on achieving broader health outcomes.  When treatment is only available for 40% of those in urgent need, and prevention is only available for 20% of individuals, the bottom line is that “we need to focus on results,” said El-Sadr.

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