Chioma Nwuba Wows the Crowd at AIDS 2012

Chioma Nwuba at AIDS 2012 discussing sustainability and local ownership.

Chioma Nwuba at AIDS 2012 discussing sustainability and local ownership. (Photo credit: S. Holtz/MSH)

The Kwara state of west-central Nigeria suffers many health-related challenges: an HIV prevalence rate of 2.2 %, a large geographic area, difficult terrain, a rural population, poor access to health facilities, long waiting time at facilities, and shortages of human resources for health. These are some of the factors thought to contribute to poor uptake of HIV testing and CD4 investigation (a test to determine whether or not a patient is eligible for HIV treatment) and the high level of attrition of patients living with HIV at all stages of the treatment process — from HIV testing to commencement of treatment to long-term treatment.

Enter Chioma Nwuba, laboratory specialist with the Prevention and Organizational Systems – AIDS Care and Treatment Project (ProACT) in Kwara state to the XIX International AIDS Conference. On Wednesday, July 25, Chioma presented “A laboratory-based approach to reduce loss to follow-up of HIV positive clients” to a standing-room only crowd at the oral abstract session on HIV linkage retention in care. She described the “MSH” leadership and management approach used by the ProACT project: The hospital management committee assessed the situation and made decisions that ultimately streamlined service delivery at the facility — ensuring sustainability and local ownership.

Thanks to the intervention: data clerks now fill laboratory request forms instead of clinicians; lab technicians collect and test blood rather than clinicians; escort services are strengthened so patients are enrolled and undergo lab tests on the same day; lab tests are provided Monday through Friday rather than just once a week; and test results are provided quickly to ensure initiation on treatment.

Twelve months after the intervention, the number of clients accessing CD4 investigations increased from 53.8% to 93.3%, the number of clients lost along the treatment process reduced from 58.7% to 10.7%, turnaround time for certain test results decreased from 7 days to 24 hours and the average client wait time decreased from 4 to 1.5 hours.

The project staff have found that strengthening laboratory systems helps increase uptake of CD4 investigations, shorten client waiting time and ultimately reduces loss-to-follow-up, especially among clients attending clinics from hard to reach communities with difficult terrains.

ProACT is a five-year, 60-million-dollar, follow-on project to the Nigeria Leadership Management and Sustainability (LMS) AIDS Care and Treatment Project (LMS-ACT). ProACT supports HIV & AIDS and TB services in six Nigerian states: Kogi, Niger, Kwara, Kebbi, Taraba, and Adamawa. The project places a strong emphasis on building the capacity of government and civil society organizations to strengthen health and HIV & AIDS systems for delivery of integrated health and HIV & AIDS and TB services.


Day 5: Living and Aging with HIV, Dying from TB and NCDs

Judith Currier speaking at Friday's plenary, XIX International AIDS Conference (AIDS 2012) Washington DC.  © IAS/Ryan Rayburn -

Judith Currier speaking at Friday’s plenary, XIX International AIDS Conference (AIDS 2012) Washington DC. © IAS/Ryan Rayburn –

Volunteers were handing out t-shirts as we arrived at Friday’s plenary of the XIX International AIDS Conference. When Marie from Results South Africa asked all t-shirt recipients to stand, over a quarter of the delegates rose from their chairs. These individuals represented the percentage of people worldwide who are co-infected with HIV and tuberculosis (TB). This powerful metaphor — 25 % of the people in the room on their feet — highlighted the morning’s theme: integrating HIV/AIDS care and treatment into disease-specific and broader health services.

The “Bell Tolls” For HIV & TB

The session’s first presentation, “Science and Implementation to Turn the Tide”, was delivered by Dr. Tony Harries, senior advisor at the International Union Against Tuberculosis and Lung Disease. Dr. Harries began by stating that 350,000 people had died from HIV/TB co-infection in 2010, and that many of these deaths were preventable.

With evidence-based research and World Health Organization (WHO) recommendations, Dr. Harries argued that co-diagnosis, early ART, and isoniazid preventative therapy (IPT) are answers to the pressing problem of increasing HIV/TB co-infection.

Harries also emphasized a need for “better, cheaper, and quicker” TB diagnostic tests. He explained the benefits of two diagnostics: Xpert MTB/Rif, which provides TB test results in two hours, and Urine TB LAM, which derives a diagnosis in just 30 minutes. “Diagnosis is not just about accuracy,” Dr Harries explained. “It is also about feasibility, speed, costs, and overall impact in saving lives.”

Harris concluded his presentation by urging health professionals to address HIV/TB co-infection by advocating for improved policy and practice, conducting needed research, implementing evidence-based strategies, and tackling poverty, which drives the epidemic. After this call to action, Dr. Harris closed with powerful quote from the famous British poet, lawyer and priest, John Donne: “Any man’s death diminishes me because I am involved in Mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.”

Aging with HIV — Dying from NCDs

Dr. Judith Currier from the University of California then took the stage to present her talk on “Non-communicable Diseases (NCDs) and Aging in HIV.” She began by praising the public health community for supporting improved access to ARVs, which has extended the lives of many people. She shared positive results that show half of all people living with HIV in the US by 2020 will be over the age of 50.

While enjoying the many benefits of longer lives, Dr. Currier also explained that this longevity puts HIV patients at risk for other health problems, including NCDs. The most prevalent NCDs impacting HIV patients today include cardio-vascular disease, cancer, diabetes, and chronic respiratory disease. In 2008, 36 million people died of NCDs. To address the crisis of NCDs among HIV patients, Dr. Currier suggested the following interventions: (1) improved screening and monitoring for NCDs; (2) early diagnosis of NCDs in TB patients and prompt care; (3) smoking cessation interventions; (4) dietary and exercise education; (5) earlier start of ART; (6) tailored ART regiments to reduce the risk of NCDs; (7) expanded global use of safer ART drugs; (8) evaluated treatment for NCDs in HIV patients; and (9) integrated screening and treatment of NCDs in HIV treatment programs.

“HIV and NCD epidemics are colliding on a global scale and failure to address these problems could lead to an erosion of ART benefits,” Dr. Currier warned. In her closing statement, Dr. Currier left the audience with a call to action, punctuated with a collective mandate to “Make healthy aging with HIV an achievable goal.”

Improving Health Systems for HIV

The final presentation, “Optimization, Effectiveness and Efficiency of Service Delivery” was facilitated by Yogan Pillay, Deputy Director General for South Africa’s Department of Health, Strategic Health Programs. Pillay began his speech with praise for South Africa’s recent success in testing 20 million residents for HIV, enrolling 1.7 million people in ART (since 2004), circumcising 500,000 men in the past year, and reducing the nation’s vertical transmission rate from 8% in 2008 to 2.7% in 2011. Despite these promising trends, Pillay cautioned that South Africa’s advances cannot be sustained without greater health system efficiency and effectiveness. “We are treating more people so we need a health and social system that can support [them],” he explained.

To improve health system efficiencies, Pillay urged the community to: increase spending on high impact interventions; improve efficiency of direct service delivery; and reduce spending on indirect costs. Pillay emphasized cost analysis as a means to help health leaders identify the correct spending mix to achieve optimal outcomes. To improve cost effectiveness, Pillay suggested service integration, resource tracking, and conducting an expenditure analysis across funders to identify inefficiencies. Pillay also recommended that the community work collaboratively to improve national health plans by optimizing service delivery models, harmonizing and improving different actors, identifying bottlenecks, highlighting equity concerns, developing research networks and conducting further research on sustainability.

Pillay concluded by emphasizing the importance of political will and collaboration in enhancing the quality and effectiveness of national health systems: “Countries need to take the lead!” he urged, “Partners and countries can fill the investment gap together!”

Yogan Pillay describing South Africa's health system at Friday's plenary, XIX International AIDS Conference (AIDS 2012) Washington DC. © IAS/Ryan Rayburn -

Yogan Pillay describing South Africa’s health system at Friday’s plenary, XIX International AIDS Conference (AIDS 2012) Washington DC. © IAS/Ryan Rayburn –

These speeches set the stage for an inspiring final day of the conference while also reinforcing the current global HIV needs and the evidence-based recommendations for an effective response. While the t-shirt exercise was daunting for some, the three presentations left conference participants with an urgency to act, strategies to employ, and evidence to motivate their continued response to the ever-evolving HIV pandemic.

Marie articulated this hope and call as she closed the t-shirt exercise saying: “Let’s move past one in four deaths from TB and celebrate together when we meet again in Melbourne!”

Jessica Charles is communications specialist at MSH’s Center for Health Services.

HIV and Health System Strengthening in Fragile States: Improving HIV Prevention, Care and Treatment

AIDS 2012 Fragile States panel

Panelists at the session HIV and health system strengthening in fragile states, July 26 at AIDS 2012 conference. (Photo credit: S. Holtz/MSH)

MSH in collaboration with the International Rescue Committee (IRC) and Physicians for Human Rights (PHR) sponsored a lively satellite session at the XIX International AIDS Conference in Washington DC discussing, “What are the keys to working on HIV & AIDS in fragile states?” Moderated by Susannah Sirkin of PHR, the session included an exciting interchange among panelists and delegates in the audience.

MSH President Dr. Jonathan Quick led off the discussion with a number of observations on fragile states, which included the point that a state which is not functioning effectively, (inadequate services, high levels of violence, etc.) — regardless of the cause — could be considered fragile. Each fragile state is unique, but all face similar challenges in that access to health services is difficult; often the population, at least in certain regions, must cope with considerable violence and insecurity.

The panelists, Peter Mutanda and Aminul Islam of IRC and I, contributed insights into the many vexing questions posed by dealing with HIV in fragile states where governments and society are overwhelmed by other problems and challenges that at times seem to dwarf the issue of HIV. In some fragile states, the prevalence of HIV is relatively low. These countries need to balance the immediate crises they face and the large numbers of preventable maternal and child deaths with the need to deal with HIV now to forestall a more serious epidemic down the road.

Members of the audience brought up fascinating examples of work that NGOs and ministries have done trying to deal with HIV in such fragile states as Democratic Republic of the Congo and Somalia. The discussion included these key issues:

  • What can we learn from fragile states where, despite overwhelming problems, some health programs are effective?
  • How should fragile states prioritize HIV amid other concerns?
  • What should be done when data are poor or non-existent?  How high a priority should fragile states place on obtaining better epidemiologic and surveillance data versus other pressing needs?
  • In fragile states where donors provide most health funding, how can country ownership of health programming be obtained? Who is ultimately responsible for deciding on health priorities, given the fact that ministries of health in many fragile states are barely functioning?

While we didn’t necessarily provide answers to these challenging questions, the discussion was stimulating and thoughtful for all who attended — and gave all of us a lot to think about as we return to work on strengthening health systems for HIV in fragile states.

Steve Solter, MD, MPH, is MSH’s country lead and technical lead on fragile states. MSH is currently working with partners in several fragile states, including South Sudan, Democratic Republic of the Congo, Afghanistan, Haiti, and Liberia.


Day 4: Listening, Learning from Marginalized Populations

After 3 days of plenaries — complete w/ scientists & rock stars, challenges & solutions, and a call for focusing on women & girls — Thursday’s plenary focused on some of the most vulnerable & at-risk populations: men who have sex w/ men (MSM), sex workers, injection drug users, and transgenders.

Related Reading: Reaching the Most Vulnerable Populations: A Health and Human Rights Imperative

Reaching the Most Vulnerable Populations: A Health and Human Rights Imperative

Debbie McMillan of Transgender Health Empowerment speaking at the Thursday plenary, XIX International AIDS Conference (AIDS 2012) Washington DC. © IAS/Steve Shapiro -

Debbie McMillan of Transgender Health Empowerment speaking at the Thursday plenary. XIX International AIDS Conference (AIDS 2012) Washington DC — as delegates wearing “Statue of Liberty” crowns listen. © IAS/Steve Shapiro –

Related Reading: Listening, Learning from Marginalized Populations (via Storify)

After three days of plenaries — complete with scientists and rock stars, challenges and solutions, and a call for focusing on women and girls — the day four plenary focused on some of the most vulnerable, marginalized, and at-risk populations: men who have sex with men (MSM), sex workers, injection drug users, and transgendered people.

Men Who Have Sex with Men

Paul Semugoma of the Global Forum on MSM and HIV opened Thursday’s plenary with the stark facts about men who have sex with men (MSM). Semugoma urged delegates to “move from being friendly to MSM to being competent in getting them care.”

MSM are at particular risk of HIV, sexually-transmitted infections (STI), and high viral load partners. “If you don’t ask about sexual orientation in the examining room, then you don’t know the patient is high risk. Health workers are uniquely placed gate keepers, but when they don’t know about MSM, they are blind.”

Interventions needed to decrease HIV risk in MSM include: behavioral change, pre-exposure prophylaxis, condoms, and antiretroviral therapy (ART). MSM also are affected by criminalization and targeted by stigma.

Semugoma issued an urgent call to action to end invisibility of MSM in the epidemiology, service delivery, and decisionmaking. We must “take our heads out of the sand,” Semugoma implored. “We cannot achieve an AIDS-free generation without MSM. We need to fight stigma, ignorance, and stand in solidarity with colleagues who are beaten or killed for advocating for MSM, such as David Kato in Uganda.”

No drug users? No sex workers? No international AIDS conference

Cheryl Overs at the Thursday plenary, XIX International AIDS Conference (AIDS 2012) Washington, DC. © IAS/Steve Shapiro -

Cheryl Overs at the Thursday plenary, XIX International AIDS Conference (AIDS 2012) Washington, DC. © IAS/Steve Shapiro –

People distributed green Styrofoam “Statue of Liberty” crowns along with signs stating: “No drug users? No sex workers? No internat’l AIDS conference” as Cheryl Overs of the Global Network of Sex Work Projects, and a researcher from Melbourne, Australia, began speaking.

Drug users and sex workers have been banned from attending the XIX International AIDS conference due to travel restrictions currently in place in the US.

Overs spoke about the social exclusion, rejection, poverty, and lack of information facing sex workers. HIV tests can often lead to criminal prosecution of sex workers and sex workers have less rights and less choice. “The HIV epidemic is being fueled by repression,” said Overs. “The greatest threat to the health and human rights of sex workers is the inability to find a safe place to work.”

She showed a video taken of a “rescue” of sex workers and said these raids ignored the agony and the rights of the sex workers. “We need a law that gets commercial sex out of dangerous places and into safer ones.” She urged sex work to be made legal and called on governments to make the decision to do this — “the decision is free”.

She cited networks of sex workers helping other sex workers. “We need meaningful participation. Sex workers represent ‘real life’ — not epidemiological categories.” She called for a repeal of the PEPFAR Anti-Prostitution Pledge and for a revision to laws so that sex workers could legally enter the US.

Nothing About Us, Without Us

Debbie McMillan, risk counseling specialist at Transgender Health Empowerment, began by showing videotaped remarks from sex workers and injection drug users gathered in Calcutta and Kiev, because they were barred from entering the US to attend the conference. “We are all human beings, we all have rights.” Lifting the travel ban was not an achievement but a mistake that was fixed, she said.

Debbie is a transgender African-American woman who used to be a drug user and sex worker. She is convinced she contracted HIV in prison. She said that she represents people at the “height of the crisis” that should be included in the programs and conferences.

“I went to the street at age 14 and became a commercial sex worker because I thought it was the only place for someone like me. I got high to dull the reality.” She cited clean syringe programs as a key component to fighting HIV.

“My mother was the only person who completely accepted me. She had 1 cup, 1 fork, 1 spoon, 1 plate. At some point she got infected with HIV and died of complications from AIDS. I had to view my mother’s body while in shackles and handcuffs. Two months later, I was diagnosed with HIV at 20 years old.”

There is no bedside manner from health professionals for transgender people, noted McMillan. The Object Bridge LGBT Program for HIV people saved her life.

“I don’t want to be an outsider looking in. I collaborate with my peers in Calcutta and Kiev because they can’t be here. We need to have a conference where all can participate. Nothing about us, without us.”

Going Beyond 15 Million on Treatment by 2015

Gottfried Hirnschall, Director of HIV at the World Health Organization (WHO) in Switzerland, said that getting 15 million on treatment by 2015 was achievable and noted antiretroviral therapy (ART) scale-up successes in Rwanda, Malawi and Cambodia. He also noted that the evidence is now tipping toward earlier initiation of ART and said it has proven cost-effective.

Hirnschall said we need to work now to aaddress gaps for future scale-up, including considering Option B+, “test, treat and retain” method. He also noted the importance of provider initiated testing and counselling.

Reflections on AIDS 2012: Shameza David

Shameza David, AIDS 2012 Poster Presentation. (Photo credit: S. Holtz/MSH)

Shameza David, AIDS 2012 Poster Presentation. (Photo credit: S. Holtz/MSH)

The thrill of having the opportunity to participate in the XIX International AIDS Conference began some months ago. The International AIDS Society accepted an abstract I authored with colleagues for a poster exhibition. This excitement became more real when I learned that I was one of three winners of an MSH internal abstract contest, and would be given the chance to travel to Washington D.C. to attend the conference and present our poster, “Leadership and Management Training increasing male involvement in PMTCT.”

I could barely sleep on Sunday night. I was nervously thinking about presenting the poster at the conference the next day. (I would have been a lot more nervous had it not been for the practice session held by MSH that helped to prepare us for presenting our posters in a clear and concise manner!)

Coming from a small city like Georgetown, Guyana, I could not conceive the magnitude of the conference or the sheer size of the convention center structure.  From the opening day I was blown away by the number of delegates, presenters, exhibitors and speakers from literally all over the world — all involved in some way in the fight against HIV & AIDS — filling the Walter. E. Washington convention center.

I felt privileged to be part of Management Sciences for Health and be surrounded by warm, welcoming supportive colleagues from our global, hardworking family.

The theme of the AIDS 2012 conference, “Turning the Tide,” flowed throughout the week, from the opening plenary to the closing session. I had goose bumps listening to the passion and conviction with which panelists spoke about their personal experiences and struggles they fought and overcame in the pursuit of reducing the incidence and impact of HIV on lives and livelihoods. These plenary sessions were rich in content, and highlighted studies and interventions, and generated new perspectives that could enhance our existing programs at home to create stronger impact. For example, two plenary sessions on preventing HIV among commercial sex workers highlighted a key group that we’ve missed during our intervention: the regular clients of sex workers. The speakers underscored how initiating behavior change interventions with regular partners could make it easier for commercial sex workers to negotiate condom use in their regular relationships.

Being part of the MSH booth was an excellent way to get a picture of the diversity of people attending the conference. Interacting with those who stopped by revealed delegates from an array of organizations and groups: clinical, behavioral, social, academic, faith-based, and community-based, among many others. It was heartening to find that many people knew of our organization and took an interest in one or more of our several programs. Also, visiting the booths of other organizations was useful for knowledge exchange on programs and resources.

This week will resonate with me for a long time, and I will use the journey home to reflect on the wealth of information shared. I am grateful to MSH for affording me this opportunity, and I return home re-energized and invigorated to continue our work as we contribute towards the shared vision of an AIDS- free generation, and someday soon, the end of AIDS.

Shameza David is program officer for the second phase of the MSH-led Guyana HIV/AIDS Reduction and Prevention Program (GHARP II), funded by USAID.

Emerging World Powers: Leadership to Turn the Tide

XIX International AIDS Conference (AIDS 2012) Washington DC. Special Session: China, India, South Africa, Brazil: How Will They Use Their Leadership to Advance the AIDS Response?  Aradhana Johri. © IAS/Ryan Rayburn -

Aradhana Johri speaking at the XIX International AIDS Conference (AIDS 2012) Special Session: “China, India, South Africa, Brazil: How Will They Use Their Leadership to Advance the AIDS Response?” © IAS/Ryan Rayburn –

The similarities facing China, India, South Africa, and Brazil don’t necessarily jump off the page. However, important commonalities exist that the global health community needs to examine — and perhaps model in low income countries.

China, India, South Africa, and Brazil are emerging world powers that have made important advancements in changing the course of the HIV & AIDS epidemic in their countries.

At a special session of the XIX International AIDS Conference on Tuesday, July 24, hosted by Stephen Morrison of the Center for Strategic and International Studies and anchored by renowned economist, Jeffrey Sachs, high level speakers from each of these countries reflected on significant activities that changed their country’s course in HIV & AIDS management. The leaders also discussed how their countries can help lead the way in the fight against the epidemic.

Three themes developed from the conversation of how these countries were able to successfully manage the epidemic in their countries: (1) A country must invest in health not as the end goal, but as a critical instrument of economic development. (2) Reducing the cost of antiretrovirals (ARVs) is critical to get more people on treatment quickly (each country had a different approach). (3) A strong, educated leadership makes the difference. It is the Ministry of Health and global health professionals job to educate government leaders on health.

The South African Health Minister, Dr Pakishe Aaron Motsoaledi, said the focus on HIV & AIDS is what made the difference for his country. The government worked with partners to dramatically reduce the cost of ARVs by 53% which helped get 1.7M people on treatment. “2009 was our turning point,” he said. “There was a real commitment made by the Government at all levels to improve health impact.”

In China, over 80% of the AIDS budget is from the Chinese government directly, explained Dr Wu Zunyou, director of the National Center for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention. The trigger point was the SARS outbreak: leadership made rapid changes to control the outbreak and their mindset changed to focus on respecting health as a human right and protecting marginalized groups.

Dr Dirceu Greco, who has served as a member of the Brazilian Ministry of Health’s National Commission on AIDS, explains that Brazil set standards early, owned 100% of the response, and most importantly has developed the world’s largest public health system with over 100 million people in the system. Brazil invested in health, not just HIV and that was crucial to curbing the disease in Brazil.

India dramatically scaled up their HIV program to manage the HIV epidemic. From the beginning, they stuck to a scientific, evidence-based approach when addressing the concentrated epidemic in India. Aradhana Johri of India’s National AIDS Control Organisation, said that the key was to never lose the focus on prevention efforts.

As middle income countries, India, China, Brazil, and South Africa have had some advantages in managing the epidemic; the world’s poorest countries may be able to adapt some of these approaches to change the tide in their countries. As these four countries move forward, they must lead by example and show other countries how to face the challenges that still remain in ensuring sustainability, fighting stigma, and reducing drug costs and, hopefully one day soon, immunization prices.

Jeffery Sachs closed the discussion, saying: “We are at a vital crossroads; the Global Fund is in financial crisis.” He encouraged the presenters not only to be the voice in public health, but within the leadership of The Global Fund. He asked the countries to invest in The Global Fund, so the world can continue to see significant changes in the fight against AIDS, Tuberculosis, and Malaria.

Watch the special session: “China, India, South Africa, Brazil: How Will They Use Their Leadership to Advance the AIDS Response?”

Margaret Hartley is MSH’s knowledge exchange associate.

On Day 3, Three Women, Three Calls: Keep Mothers Alive, Make Women Count, Invest in Programs for Girls

XIX International AIDS Conference (AIDS 2012) Washington D.C. Wednesday Plenary Session Linda H.ScruggsAIDS Alliance for Children, Youth and FamiliesUnited StatesUSA and Canada © IAS/Ryan Rayburn -

XIX International AIDS Conference (AIDS 2012) Washington DC, Wednesday Plenary Session, Linda H. Scruggs. © IAS/Ryan Rayburn –

Day three of the XIX International AIDS Conference opened with an impassioned plenary by three powerful women speakers, calling for more concerted action for women and girls living with HIV, particularly adolescent girls.

Dr Chewe Luo, Senior Advisor HIV/AIDS, UNICEF, spoke about the Global Plan to Eliminate New HIV Infections in Children by 2015 and Keeping Their Mothers Alive. Targets of the plan include: 1) Reducing infections in children by 90%. (In 2011, 333,000 children were infected with HIV, with 29% of new infections in Democratic Republic of the Congo, Nigeria and Malawi.) 2) Reducing HIV-related maternal deaths of women during pregnancy, delivery or post-delivery, by 50% by 2015.  3) Eliminating mother-to-child-transmission.

Luo highlighted the benefits of giving triple therapy or single dose Nevirapene throughout breast feeding; this could reduce mother-to-child-transmission to less than 5%. She described pilot studies in 11 countries and improvements in access to antiretrovirals (ARVs) for women: from 48% in 2010 to 57% in 2011. Despite improvements in Eastern and Southern Africa, the Caribbean, Eastern Europe and Central Asia, “we still need to do better in Western Africa,” she said. The decline in HIV infections in children was roughly 10.8%  from 2010 to 2011 but, “this is not enough,” said Luo. “We should have reached 20% by now.”

She cautioned that treatment should have started earlier for pregnant women and cited several options that countries have, mostly based on cost: Option A and B which are treatment therapies for the mother for a limited time and the newer Option B+ which provides triple ART for pregnant women for life.

“We will not achieve the goal of eliminating PMTCT without some serious innovations. And that’s what this strategy [Option B+] is about,” said Luo.


Malawi is the first country to implement Option B+. “We need to look at PMTCT as a component of ART and access treatment early,” said Luo. “This is the bottom line for me.”

“Option B+ must be scaled up. I applaud Malawi for being so bold.” Benefits of Option B+ include reduced infant HIV infection.

Luo then turned her attention to the “unacceptable” percentage of children not receiving ART. “We are failing to reach children,” she said.

She ended with a call to action. We need to: 1) simplify our prevention approach and integrate PMTCT and ART programs at the community level; 2) introduce innovative approaches to reach adolescent girls and pregnant teens; 3) change treatment regimens for children; and 4) collaborate with community groups.


Linda Scruggs, a consultant and a woman living with AIDS, delivered an inspirational account of her own struggles and brought her rousing comprehensive agenda to “Make Women Count” and end gender discrimination and stigma to a standing ovation. Scruggs told many stories of both gender inequity and gender empowerment.

“For the last 20 years, women have been asking for an international platform for their rights, to count us in. Today I stand to give us direction and a recipe for change. We want women  to work with women that have the tools for us, by us, with us. … It is not enough to create a task force or write a paper, what we need is to be part of the solution. We are the Mothers of the Earth.”

Linda reflected: “What does a woman with no self- esteem look like?  What does a woman whose uncle molested her look like? What is a woman who can’t read or write, broken and voiceless? That woman was me.”

Linda told stories of women, broken or affected by disease. “We are at the table and a force to be reckoned with. We need a big change and need to create jobs and training for HIV positive women.”


Dr. Geeta Rao Gupta, Deputy Executive Director of UNICEF, also made the case to turn the tide for adolescent girls and highlighted the need for gender equality. Adolescent girls aged 15 to 24 bear the brunt of the epidemic. Of the 4.8 million young people with AIDS, 3 million of them are girls.

The challenges of adolescent girls are immense: early sexual debut, child marriage, increased risk of HIV and STIs, sexual violence, and risk of early pregnancy and HIV infection. Many are forced early into transactional sex to survive or they depend on older men to survive. Most lack basic information on condoms or sex education.

Geeta offered recommendations to accelerate the pace of protection for adolescent girls:

  1. We need relevant national plans for high impact with emphasis on girls. Few country plans include anything about adolescent girls.
  2. We need to educate girls — empower them to make choices.
  3. We need to start early; make adolescents visible in routine data systems and follow their health status after age 5. (Right now, they don’t appear in the data unless they get pregnant or contract HIV and then they are included with adult data.)
  4. We need to invest in innovations to reach adolescent girls through social media and networks.
  5. We need to engage with adolescents as partners.

As Anthony Lake of UNICEF has so eloquently said: “We invest so much in keeping girls alive in their first decade of life. We must not lose them in the second.”

We need a world that is AIDS-free and fair for all women and girls. That must be our legacy.

Barbara Ayotte is MSH’s director of strategic communications.

Global Post Covers MSH Satellite Session on HIV and Non-Communicable Diseases

MSH’s satellite session on HIV and Non-Communicable Diseases is featured among the Global Post‘s highlights from AIDS 2012.

Learn more about the session:

The session included opening remarks by MSH’s President and CEO, Dr. Jonathan Quick, and Global Post reporter John Donnelly. Donnelly also authored the MSH 40th anniversary book, Go to the People: 40 Years of Improving Health.

The Vision for Success Beyond MDG 6: Chronic NCDs, Health System Strengthening, and UHC

2012 July 22 AIDS 2012 Satellite Session: Beyond MDG 6

Panelists at AIDS 2012 Satellite Session: Beyond MDG 6, July 22, 2012. (Photo credit: S. Holtz/MSH)

On Sunday, July 22, 2012, Management Sciences for Health (MSH) hosted a satellite session, Beyond MDG 6: HIV and Chronic NCDs: Integrating Health Systems Towards Universal Health Coverage at the XIX International AIDS Conference (AIDS 2012). The session panelists were (left to right): Dr Ayoub Magimba, Till Baernighausen, Dr Jemima Kamano, John Donnelly (moderator), Sir George Alleyne, Dr Doyin Oluwole, and Dr Jonathan D. Quick

This week at the XIX International AIDS Conference — as panelists and pundits debate whether an AIDS-free generation is actually possible — we must not neglect the other chronic diseases that remain an emerging and alarming threat to both aging HIV-positive and sero-negative populations in these settings. Today, chronic non-communicable diseases (C-NCDs), including cancer, lung and heart disease, and diabetes, kill over 28 million people annually in low and middle-income countries, many of whom are HIV-positive.

According to Till Baernighausen of the Harvard School of Public Health, the total number of HIV-positive people aged 50 years and older is likely to triple over the coming decades from 3.1 million in 2011 to maybe 9 or 10 million in 2040. “We would really expect dramatic increases for the need for C-NCD screening and treatment.”


Once deemed a death sentence, HIV is now considered a manageable chronic condition through the use of lifelong antiretroviral therapy (ART). HIV-positive individuals are now living longer, particularly in resource-limited settings where HIV care and treatment were not previously available. In fact, through the global scale-up of HIV and AIDS services, health systems in low- and middle-income countries are now better prepared to tackle other C-NCDs — like cancers, diabetes, chronic lung diseases, and cardiovascular diseases — by leveraging the existing investments, infrastructure, and systems put in place in recent decades.


Over a decade ago, many critics said that bringing life-saving HIV treatment to the most hard-to-reach areas would be impossible. Yet today, more than 8 million people have access to antiretroviral treatment in low-and middle-income countries. The same models used for lifelong ART can be adapted and used for managing and monitoring patients with other C-NCDs. MSH firmly believes we can apply the lessons learned from our experiences with HIV to the C-NCD epidemic. For example, service delivery models — e.g. scaling up of ART and prevention of mother-to-child transmission (PMTCT) — innovations in funding, health care financing models, pricing for drugs and laboratory supplies and equipment, and new technologies for care diagnosis, among other innovations, provide a model for chronic diseases in low- and middle-income countries.

While proven solutions to tackle such conditions exist, the global health community is only now starting to realize the importance of designing cost-efficient, integrated health systems. According to Dr. Jemima Kamano of AMPATH, “One of the hardest things for me as a practicing clinician in Africa is to sit at the HIV clinic and treat HIV patients, counsel them and give them drugs and see them improving. But the minute they develop diabetes or hypertension, then I tell them unfortunately I can’t help them.”

By integrating current health systems and leveraging the existing groundwork laid by HIV and AIDS intervention scale-up, we can leverage existing public infrastructure, pharmaceutical supply chains, and human resources management, among other developments, to benefit patients with chronic diseases.


HIV and other C-NCDs have serious socioeconomic consequences, often creating a financial barrier for individuals in need of proper care and treatment, and forcing them to pay high out-of-pocket fees. Despite advancements in service delivery, only twenty countries worldwide currently have Universal Health Coverage (UHC) plans in which everyone can receive basic health services.

While some advocates in the AIDS community may see UHC as a threat to the provision of HIV & AIDS resources, others see it as a solution. Sir George Alleyne from the Pan American Health Organization (PAHO) reminds us that UHC is “feasible, socially desirable, and economically possible.”

“We have acceptance that UHC is possible. It is a myth that poor countries cannot afford UHC. There is no country that cannot afford UHC,” Sir Alleyne says. “It is a matter of social justice.”

According to Dr. Jonathan D. Quick, President and CEO of Management Sciences for Health, “UHC is becoming the driving vision for prevention, care and treatment of, and assuring access for, HIV positive and HIV affected people. They live long enough to get chronic diseases and to care for children — and they need the services that are provided through universal health coverage programs.”

The long-term nature of chronic diseases, including HIV, poses many challenges for the health system, but it is crucial that the prevention, care, and treatment of chronic disease be integrated in order to save many more lives.

MSH believes that in order to effectively combat the rise of C-NCDs — and turn the tide against HIV and AIDS — we must strengthen current health systems while leveraging existing platforms and ensuring access at an affordable cost in the context of UHC.

For a more in depth discussion on this topic, watch the webcast of MSH’s recent panel at the International AIDS Conference (via Kaiser Family Foundation).

Gloria Sangiwa, MD, is Management Sciences for Health’s global technical lead for chronic non-communicable diseases and the director of technical quality and innovation in MSH’s Center for Health Services.