Director of The Center for Global Health Policy Christine Lubinski recalls her recent trip to South Africa and Zambia, where she and other Center staff hosted five congressional staff members on tours of U.S. government funded programs to address HIV and TB.
Additional resources are essential to scale up prevention and treatment to ultimately reach the tipping point of the HIV epidemic in Zambia, said Dr. Jeff Stringer, director of the Center for Infectious Disease Research in Zambia (CIDRZ). And he said the Zambians are unprepared to manage their HIV program without substantial outside help—either programmatically or financially.
CIDRZ is a Zambian non-profit affiliated with the University of Alabama at Birmingham (UAB). About 80 percent of their funding comes from the U.S. government—a combination of research and programmatic funds. CIDRZ is a major provider of HIV care and treatment in Zambia through the support of 78 Ministry of Health sites that have enrolled more than one-quarter of a million people in ongoing care with almost 164,000 individuals on antiretroviral therapy (ART). CIDRZ may be the largest single-country ART program supported by the President’s Emergency Plan for AIDS Relief anywhere.
But even after more than a decade in Zambia, Stringer argued it will be another decade before the government of Zambia can effectively manage their own HIV response, and even then they will not have the resources to pay for it without donor support.
In addition to the provision of HIV treatment to adults and children, CIDRZ has a major prevention of mother-to-child transmission (PMTCT) program, engaged in clinical care quality improvement, community outreach and coordination, TB/HIV services, voluntary counseling and testing services, cervical cancer screening, laboratory management, pharmacy management, and monitoring and evaluation. They are also working to spearhead neonatal circumcision in Zambia.
Stringer hosted a luncheon for us and our congressional colleagues and highlighted the importance of their approach of integrating and building HIV program capacity at government health care sites. While they have made enormous progress in expanding access to HIV treatment, the demand keeps going up and the number of programs hasn’t kept pace.
Deputy Medical Director at CIDRZ Dr. Carolyn Bolton told our group that they had tried to streamline the services they provided at the sites – being less comprehensive to expand the number of sites, but that approach didn’t work. In order to keep the quality of the programs up, they are resigned to not increasing the number of sites for service provision at this point. Bolton said that they had learned a great deal and had done many things to decrease costs, including developing their own laboratory services. But she said she worries that additional resources for lifesaving drugs and reagents will not be forthcoming, and that flat funding is also limiting their ability to learn how to deliver services better and more effectively.
Among other issues, we spoke with Stringer and Bolton about the move away from stavudine to tenofovir. New patients currently are being started on tenofovir. Bolton said they struggled with this issue, in part because of the significant difference in cost—tenofovir is much more expensive. But the bottom line is that the side effects of stavudine for a number of individuals are extremely debilitating and tenofovir has a much better resistance profile, so there are more treatment options for those failing a first-line, tenofovir-based regimen, making it cost-effective in the long run.