Time To Start Doing More With Less Money. 22/07/09

CAPE TOWN, 21 July (PLUSNEWS) - While the worldwide AIDS community bemoans the global economic crisis and its impact on funding streams for the HIV/AIDS response, several speakers at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, taking place in Cape Town, South Africa, this week, called on implementers to start doing more with less.

 "We've been working towards more money for AIDS, but I'd argue we haven't done enough to ensure we're getting less AIDS for the money," said Dr Stefano Bertozzi of the National Institute for Public Health in Mexico.

 He pointed out that despite remarkable growth in the available resources for HIV/AIDS - a record $13 billion was allocated in 2008 - there has been little attempt to measure the cost-effectiveness of interventions.

 The sizeable increases in funding have put four million people in low- or middle-income countries on life-prolonging antiretroviral (ARV) treatment, but 25 years of spending on HIV prevention have failed to significantly reduce the pace of new infections, with twice as many people becoming infected every day as are started on treatment.

 Bertozzi said the AIDS community needed strategies to contain funding cuts, but also needed to improve the efficiency of AIDS spending to achieve similar or even better health outcomes with potentially less money.

 Choosing interventions more strategically would help. "We need to stop implementing large-scale programmes without measuring their effectiveness," he said, citing abstinence programmes as one example of an approach that lacked evidence to support it.

 Focused, well-managed programmes targeted at populations with the greatest need, like sex workers and injecting drug users, were the most cost-effective, as were programmes integrated with services for related health issues, such as tuberculosis (TB).

 Programmes that worked towards long-term goals, such as training new doctors and nurses, empowering women, and changing social norms, were more efficient than those with short-term targets, which looked good on annual reports but did little to change the course of the epidemic.

 "Billions of dollars are at stake, and millions of lives," warned James Kahn, of the University of California in San Francisco. Kahn introduced several presenters who had evaluated the cost-effectiveness of various HIV interventions, and noted that donors and programme implementers needed to consider the capacity of countries to spend funds, as well as the cost-effectiveness of various treatment and prevention options.

 In Lesotho, a country with an HIV prevalence of 23 percent and significant barriers to scaling up ARV coverage, 65 percent of HIV/AIDS funding came from international donors.

 An evaluation by Regien Biesma, of the Royal College of Surgeons in Ireland, found that donor spending had helped address problems like a lack of equipment, drugs and infrastructure, but had done little to counter higher-level barriers to scaling up, such as an overly centralized health system and a lack of management capacity to implement policies. Donors had also failed to harmonize their efforts, or to empower the government to set priorities.