060202 HIV kurs Panel discussion rev1

Panel discussionARV treatment in low-income contextPriority setting considerations: 

Panel discussion ARV treatment in low-income context Priority setting considerations Maria Lorena Dini Pou del Castillo, Uruguay Girum Mekonnen, Ethiopia Fanta Sangho, Mali Olivia Veit, Switzerland

The WHO ”3 by 5” initiative - Progress: 

The WHO ”3 by 5” initiative - Progress June 2003: 0.4 million on ART June 2005: 1.0 million on ART (0.5 million in sub-Saharan Africa) Projected no. on ART 2006: 3.0 million 2007: 4.9 million 2008: 6.6 million 2009: 8.3 million 2010: 9.8 million

Resources available and required(in US $ billions. UNAIDS, 2005) : 

Resources available and required (in US $ billions. UNAIDS, 2005) Available Projected needs Total Treatment Prevention 2005: 6.1 2006: 8.3 14.9 3.0 8.4 2007: 8.9 18.1 4.0 10.0 2008: 10.0 22.1 5.3 11.4

UNAIDS - statements: 

UNAIDS - statements ”More opportunities for HIV-prevention than ever before” ”One key finding…is that the availability of treatment increases the number of people who access key prevention services, such as testing and counselling” (Dr. Peter Piot)

Experiences and views from the members of the panel: 

Experiences and views from the members of the panel Do the UNAIDS statements reflect the situation in your country? What is the situation regarding human and institutional capacity for treatment activities and prevention ? Influx of funds for treatment ? Sources: Global Fund, PEPFAR, Other ? How are treatment activities prioritized in your country ? Should it be given higher or lower priority ? How to ensure a fair distribution ? Do treatment activities lead to increased or decreased attention to prevention ?

Panel discussionARV treatment in low-income contextPriority setting considerations: 

Panel discussion ARV treatment in low-income context Priority setting considerations Maria Lorena Dini Pou del Castillo, Uruguay Girum Mekonnen, Ethiopia Fanta Sangho, Mali Olivia Veit, Switzerland

Rationing antiretroviral therapy Hard choices in resource poor settings*: 

Rationing antiretroviral therapy Hard choices in resource poor settings* Priority to specific groups ? HIV-positive mothers and their children Core government workers (Health workers, teachers, judges, police officers) Poor people who can not afford private care Priority to specific geographic areas where infrastructure most easily can be established * Based on Rosen et al. Lancet 2005; 365: 354-56

Rationing antiretroviral therapy Hard choices in resource poor settings: 

Rationing antiretroviral therapy Hard choices in resource poor settings Pragmatic approaches First-come - first-served Facility level Patient level Rationing by demanding co-payments Informal arrangements that favour specific groups (political, social, economic elite) Black market mechanisms

Rationing antiretroviral therapy Hard choices in resource poor settings: 

Rationing antiretroviral therapy Hard choices in resource poor settings Criteria for assessment of a rationing system Quality of system Does it result in a high rate of sucessfully treated patients ? Cost/effectiveness of the system Are necessary resources available? Human resources and infrastructure Will all eligible patients have equal access to treatment? Sustainability of the system What will be the effect on HIV-transmission?

Systems for rationing antiretroviral therapy Hard choices in resource poor settings: 

Systems for rationing antiretroviral therapy Hard choices in resource poor settings Who decides ? Politicians ? Ministries of health ? Funding agencies ? Health workers ? No clear setting of priorities ? Governments should develop explicit criteria for rationing Allow public discussion Lack of criteria leads to illicit priority setting and inequitable and inefficient provision of treatment

Panel discussionARV treatment in low-income contextPriority setting considerations: 

Panel discussion ARV treatment in low-income context Priority setting considerations Maria Lorena Dini Pou del Castillo, Uruguay Girum Mekonnen, Ethiopia Fanta Sangho, Mali Olivia Veit, Switzerland

General conclusions: 

General conclusions Multisectoral preventive programmes must be strengthen, independent of treatment initiatives Increased attention must be given to prevention as an integral part of all treatment initiatives Increased financial and technical support needed to strengthen health systems to handle effectively treatment as well as preventive efforts The human resource question must be urgently addressed by training appropriate personnel for treatment and preventive activities