The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program released the 2012 Country Operational Plan Guidance recently, which highlights seven program priorities: increasing prevention of mother–to-child transmission (PMTCT) coverage and effectiveness; improving and refining the country’s approach to treatment; programming for prevention impact; TB/HIV integration; testing and counseling; training new healthcare providers; and capacity building.
The guidance explicitly promotes investing strategically – and demonstrating impact is the central facet of that. “Our greatest urgency is to reduce new infections with the best tools we have to do so,” according to the guidance. The program priority focusing on treatment goes beyond emphasizing the need to increase the number of people that have access to treatment. The guidance stresses the need to focus on adherence and retention on antiretroviral therapy (ART) as programs mature, not only to benefit treatment outcomes at the individual level, but also to ensure the highest population level benefit possible by reducing vertical and sexual transmission.
“[In] determining an approach to treatment scale-up,” the guidelines state, “As a guideline, we need to spend every dollar mindful of the fact that it could have been used to directly save a life today with antiretroviral treatment,” and every PEPFAR team, regardless of whether they directly support treatment, should make strong performance of country treatment programs a priority.
PEPFAR’s expectations for how countries will scale up treatment will take into consideration generalized epidemics, the types of internal and external resources available in a country, and “the burden of those living with HIV and coverage rates for treatment and other key interventions for people living with HIV/AIDS.” The guidance includes the table below to help PEPFAR funding recipient countries determine treatment scale up targets taking these into consideration.
The countries highlighted in yellow in the table have the highest disease burden coupled with lower levels of treatment coverage and the lowest Global Fund resources at their disposal. “PEPFAR teams in these countries should consider raising their budgetary allocations to diagnosis and treatment over time, as needed… In yellow-highlighted countries that do not currently support direct treatment targets, these increases might represent increased technical support to treatment programs,” the guidance states. More detailed information on the table can be found on page 24 of the guidance.
Stay tuned for the next Science Speaks post on the guidance, which will look at the recommendations on TB/HIV integration.