Continued PEPFAR cuts will slow HIV treatment enrollment, reverse gains, postpone end of AIDS, global health advocacy leaders write

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That doesn’t have to happen, Health Affairs blog piece argues

collinskavanaghWhen lawmakers got together two months ago on the bipartisan, bicameral, unanimous passage of the PEPFAR Stewardship and Oversight Act, renewing authorization for the President’s Emergency Plan For AIDS Relief, the future of support for the program that has saved the lives of millions of people worldwide and protected a million babies from being born with HIV looked solid.

With the nomination of physician researcher and CDC Global AIDS Program leader Dr. Deborah Birx to become the next head of PEPFAR, the program has seemed poised to continue the successes of a response based in science and community. And one decade on, after an unprecedented acceleration of antiretroviral treatment enrollment in the hardest hit countries, those successes have been documented, a post published Monday on Health Affairs blog notes. The post, Don’t Put the Brakes on Ending AIDS, cites studies showing the speed with which treatment is made available to those who need it correlates with drops in HIV transmission.

But the post, written by amfAR public policy director Chris Collins and Health GAP senior policy analyst Matthew Kavanagh, warns that with current funding levels and proposed continued funding cuts, the pace of treatment enrollment will stall, and the numbers of new people receiving treatment through PEPFAR will plunge. With the Obama administration making final budget decisions this week for fiscal year 2015, to be released to Congress on March 4th, the post makes the case for returning to 2011 funding levels for PEPFAR for more rapid scale-up of HIV treatment.

The authors write that thanks to lower treatment costs and hundreds of millions of dollar in unexpended PEPFAR “pipeline” funds available in 2012 and 2013, the number of people started on treatment grew dramatically between 2011 and 2013. But without restoring PEPFAR funding to 2011 levels, “treatment initiation through PEPFAR could fall back to the levels of the first years of the program,” they write. That will hurt both health and economic gains, they note, citing studies that showed long-term economic returns thanks to HIV treatment programs.


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While the trajectory of treatment enrollment is now poised to plunge, weakening the attendant impact treatment has had on illness, death and new infections, that doesn’t have to happen, the authors argue. “Our estimates suggest that if President Obama and Congress can work together to reverse the PEPFAR cuts over the next two years – increasing the PEPFAR bilateral budget by $400 million in 2015 and 2016 – we can stay on our current trajectory,” they write. A graph illustrates their point, showing the steep climb of accelerated treatment scale-up between 2011 and the present, followed by the possible directions it could go next — a continued rise, a sharp drop, and a couple of paths in between. The choice, the graph indicates is one between success and failure, and the authors spell out that it is; continuing an ambitious rate  of adding people living with HIV to treatment rolls would make strides toward the United Nations goal of 15 million people on HIV treatment by the end of 2015. Doing that, they add, “also means reaching an end to the AIDS epidemic sooner.”

They are backed in this by projections of the results of accelerated treatment enrollment, laid out last year, with the launch of PEPFAR’s Blueprint: Creating an AIDS-free generation. In turn the authors write that they welcome the opportunity to review their analysis, which was based on publicly available data and consultations with experts, with those interested.

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