Global AIDS Coordinator Eric Goosby, MD, gave a plenary talk to a packed audience at the annual meeting of the Infectious Diseases Society of America entitled HIV/AIDS- Response to an Epidemic, Implications for Global Health.
There was little news in his address as he spelled out the accomplishments to date of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program—29 million people tested for HIV, 3.6 million orphans and vulnerable children served and nearly 2.5 million people on antiretroviral therapy (ART) directly supported by PEPFAR. He did note that the 2010 data was coming in now and he suspected that the treatment numbers would be in the “high 2 millions” putting PEPFAR well on its way to reaching more than 4 million people with lifesaving treatment b y 2014, its current goal.
Goosby acknowledged the difficult fiscal context and noted that finding efficiencies within the budget had allowed them to expand access to services. Savings from the cost of antiretroviral drugs has been exhausted, with the program now purchasing 92 percent of medications as generics. Now the focus has shifted to making improvements in supply management and procurement that will free up more resources. The aim is to increase pooled procurement of medication, which now stands at 50 percent. In the area of medications, Goosby also indicated that the PEPFAR program was moving d4T, or stavudine, off their formularies and actively working to discourage countries from using d4T due to the drug’s harsh side effects.
Goosby said that it was time to make difficult but appropriate decisions in the prevention arena, prioritizing the scale-up of evidence-based interventions like medical male circumcision and prevention of mother to child transmission (PMTCT). He highlighted male circumcision as a one-time intervention that has the potential to save millions of lives with a scaled implementation, and announced that PEPFAR was poised to do country-level scale up of male circumcision in Swaziland, Lesotho, and several key provinces in South Africa. In regard to PMTCT, PEPFAR has targeted six countries for major investment over the next year with the goal of testing at least 80 percent of pregnant women for HIV infection and ensuring that at least 85 percent of those who test positive are offered ART. This will require the establishment of a case management relationship with pregnant women and partnering with the World Health Organization, the Joint United Nations Program on HIV/AIDS (UNAIDS) and UNICEF to offer technical assistance to countries to help them to reach pregnant women who deliver their babies at home.
Another effort to ensure the most strategic and effective use of resources is an analysis of program expenditures that has already been completed in 14 countries and will now be expanded to 30 countries.
Goosby described the Obama Administration’s Global Health Initiative as a logical maturation to build on PEPFAR-funded medical and other service delivery platforms to expand services to the same patient populations, including prevention and treatment of other infectious diseases, maternal and child health services, clean water and more. This expansion of services does not have to be costly if we leverage existing services, he said.
Goosby highlighted the U.S. contribution to the Global Fund to Fight AIDS, TB and Malaria – a spending level that stands at $5.1 billion to date and a recent pledge to commit an additional $4 billion over the next three years. He noted that a very small number of players finance the Global Fund, and that most European countries actually reduced their contributions. Goosby said Secretary of State Hillary Clinton is committed to raising the financing of the Global Fund in diplomatic dialogue with a number of countries, including Saudi Arabia, China and South Korea.