When a report evaluating the impact of the President’s Emergency Plan For AIDS Relief produces recommendations that give little weight to the most recent major scientific breakthrough in HIV research, what will its impact on policy be?
That ended up being one of the central questions in a panel discussion April 30, at the Center for Strategic and International Studies on The Policy Implications of the Institute of Medicine’s Evaluation of PEPFAR. The first IOM PEPFAR evaluation, released in 2007, helped guide the legislation reauthorizing the program in 2008, which included changes to PEPFAR’s early funding allocation requirements for prevention efforts focused on abstinence from sex. For the second report, evaluators collected information through interviews and visits to PEPFAR countries, as well as financial, clinical and epidemiological data from 2010 to 2012. The IOM’s second evaluation of PEPFAR was released in February, nearly two years after the HPTN 052 study unequivocally linked early antiretroviral treatment for HIV with a 96 percent drop in transmitting the virus to an uninfected partner, and a greatly reduced chance of contracting tuberculosis, the leading killer of people living with HIV. The IOM evaluation acknowledges that development in several paragraphs of its Prevention section, under the heading “Interventions on the Horizon for Prevention Strategies.”
Looking at the IOM evaluation’s implications for policy at the CSIS session earlier this week were IOM Senior Program Officer Kimberly Scott, Deputy Global AIDS Coordinator Julia Martin, amfAr Public Policy Director Chris Collins, and Kaiser Family Foundation Global Health and HIV Policy Director Jennifer Kates. Kates served on the evaluating committee that put the report together through consensus.
The IOM report team was analyzing the data collected, when the HPTN 052 results came out, Kates noted, adding that she would have liked to see more time given to the development.
“An earthquake happened in the middle of this report,” he said, but the report, he added, stresses only three prevention interventions — prevention of mother to child transmission, medical circumcision for men, and approaches geared toward behavioral change. The result, he said, created a false choice between prevention and treatment, that now “is outdated,” he added.
“Treatment is prevention,” he said. “We’re in an era when the head of NIAID said we can end this epidemic.”
By contrast, Collins said, the report cautioned that PEPFAR’s transition to supporting efforts sustained by countries would necessarily slow the scale up of services. “That concerns me,” he said.
Noting that when countries do transition to maintaining their own programs that such marginalized populations as sex workers, gay men, people who use drugs, and transgender people will be in “deep, deep jeopardy,” and the “huge divide between what science tells us we can do, and what the money says,” Collins urged reading the IOM report with “its companion piece, the PEPFAR Blueprint.”
The PEPFAR Blueprint: creating an AIDS-free generation which was released three months before the IOM report, stresses the need for an accelerated scale up of HIV treatment among other interventions that have been proven effective.
What should the next report say?
“I don’t know that we need another,” Kates replied.
Collins agreed. “The science moves so fast.”