Biggest Threat to PEPFAR? Its Success, says Lancet Commentary

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Most global AIDS advocates would agree that PEPFAR is at a critical juncture, mainly because of fears that Congress and the Obama administration are set to pull back from the program in favor of a new push on maternal and child health and health system strengthening. But in an interesting commentary in the Lancet today, Peter Navario, a one-time manager of a PEPFAR-funded program, argues that PEPFAR’s biggest “liability” is its inadequate focus on patient retention and adherence.

Navario writes that concerns about adequate funding and leadership are “unlikely to derail PEPFAR,” a statement could provoke sharp debate given the widespread concerns that proposed increases for PEPFAR, from the White House and Congress, could stall the program. But his second point might be more well-received.

Navario argues that PEPFAR needs to undergo a “paradigm shift” from “emergency initiative (i.e. short-term) into a chronic care program for developing countries.” He notes that PEPFAR’s biggest success–starting 2 million people on treatment—“also means keeping 2 million people on treatment for years (and hopefully decades).”

On that front, he says PEPFAR has not done very well so far, citing a study in sub-Saharan Africa which showed nearly 40 percent of patients were no longer on treatment after 2 years.

Navario’s commentary comes as the curtain rises on the 2009 International AIDS Society conference in Cape Town, where fears run deep about a possible global pullback on AIDS funding.  The IAS is live blogging from the conference (and we will be too) and kicked off today with a series of interesting posts about everything from the G8 summit to AIDS & politics in South Africa. Stay tuned for more news as the conference gets under way in the coming days.

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