Global AIDS Ambassador discusses global health outlook and America’s role

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U.S. Global AIDS Ambassador Eric Goosby, MD (left) discusses the future of PEPFAR with Lisa Carty of the Center for Strategic and Informational Studies.

The U.S. government-led push to eliminate mother-to-child transmission of HIV by 2015 is off to a good start, according to U.S. Global AIDS Ambassador Eric Goosby, MD. He spoke last week at an event hosted by the Center for Strategic and Informational Studies (CSIS) Global Health Policy Center with Lisa Carty.

At the United Nations (UN) High-Level Meeting on AIDS in June in New York City, the U.S. government and UN secretariat announced the action plan for eliminating new HIV infections in children. The U.S. pledged $75 million in new funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), on top of the approximately $300 million allocated annually to the prevention of mother-to-child transmission (PMTCT) . Goosby updated the CSIS audience on private sector and foundation pledges to the effort so far, including $40 million from the Gates Foundation, $20 million from Chevron, $15 million from Johnson & Johnson, and added that he expected others to follow suit.

PEPFAR is using a country by country approach to strengthen PMTCT services, Goosby said, starting with an intensive review of where countries are now, and then working backwards to identify holes in the continuum of services, get rid of duplication, become more efficient and then funnel resources to close those gaps and rejuvenate country resources and interest in the issue.

Goosby also discussed the Obama administration’s emphasis on innovation and effectiveness to maximize PEPFAR’s impact, citing several examples:

  • Accelerated high-impact, cost-effective prevention, like PMTCT and male circumcision
  • Increased cost savings through pooled procurement via the Supply Chain Management System (SCMS)
  • Expanded use of generic antiretrovirals (98 percent of the approximately 20 million ARV packs purchased by PEPFAR through SCMS are generic, up from 15 percent in 2005). In 2004 care and treatment per patient per year was approximately $1,053 in Africa; by 2009 that had dropped to $453 per year, per patient.
  • Saved money by switching from air to land and sea freight – delivering life-saving drugs on-time and for less money
  • Maximized investments through better coordination with the Global Fund and elimination of parallel systems
  • Translating recent scientific advances into improved program outcomes.

When asked during the question and answer sessions how much more room there is to drive down costs with efficiencies and economies of scale, Goosby said they can continue to reap significant benefits for the next one to two years. “The next area of big savings to be achieved will be planning and implementing together with Global Fund resources,” he said.

“PEPFAR’s success is directly connected to the Global Fund continuing; without the Fund our effectiveness is markedly diminished.”

Goosby also made reference to the HPTN 052 study results released in May, which showed that HIV-infected persons on antiretroviral therapy are more than 96 percent less likely to transmit HIV to their uninfected sexual partners than those who are not on therapy. The challenge, he said, is asking individual physicians to look beyond their responsibility to an individual patient to a public health responsibility when determining who to start on treatment. Also, in times of budget constraints, how do we prioritize which populations receive treatment first? Discordant couples only? Those at high-risk of infection? Injection drug users?

“We are exploring all of these areas and considering them in our discussions,” he said.

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