Turning the Tide After AIDS 2012: Moving Toward an AIDS-Free Generation Together

President William Clinton at Closing Session of AIDS 2012. © IAS/Steve Shapiro - Commercialimage.net

President William Clinton at the closing session of AIDS 2012. © IAS/Steve Shapiro – Commercialimage.net

It’s been nearly two weeks since former President William J. Clinton closed the last session of the XIX International AIDS Conference(AIDS 2012) and delegates returned home.

This year’s conference featured commitment and calls for an AIDS-free generation, a growing interest in Option B+, and new research towards a cure.  Here are some reflections from what we learned at AIDS 2012, where we truly started “turning the tide together”.

Clinton calls for a blueprint toward an AIDS-free generation

Secretary of State Hillary Rodham Clinton at AIDS 2012. © IAS/Ryan Rayburn - Commercialimage.net

Secretary of State Hillary Rodham Clinton at AIDS 2012. © IAS/Ryan Rayburn – Commercialimage.net

Secretary Hilary Rodham Clinton announced significant funding towards preventing mother-to-child transmission (PMTCT) of HIV, South Africa’s plan for voluntary medical male circumcision, and money for “implementation research,” civil society, and country-led plans. Sec. Clinton also called on Ambassador Eric Goosby to provide a blueprint for achieving an AIDS-free generation during her plenary address. Numerous other stakeholders echoed her commitment. But, if we really want to achieve an AIDS-free generation, the $7 billion funding gap that stands between where we are now, and where we should be, will need to be erased.

Option B+ takes center stage

Dr Chewe Luo at AIDS 2012 (Photo credit: S. Holtz/MSH)

Dr Chewe Luo at AIDS 2012 (Photo credit: S. Holtz/MSH)

There is growing consensus that countries should embrace Option B+ to decrease or eliminate vertical HIV transmission. Option B+ — whereby HIV-infected pregnant women are put on antiretroviral treatment for life regardless of their CD4 count — originated in Malawi. In its first year of implementation, the country has seen a 6-fold increase in ART uptake among HIV-infected women. Many plenary speakers and presenters, including UNICEF’s Dr. Chewe Luo, praised the approach and encouraged uptake in other countries.

Elimination of pediatric AIDS by 2015

Along with Option B+, there is a renewed call to action to end pediatric HIV by 2015. MSH welcomes that discussion and the political commitment to achieve it. Great progress has been made toward this ambitious goal in the short history of preventing mother-to-child transmission of HIV: from 2009 to 2011, the number of new HIV infections in children decreased by 24% to 320,000 last year. That is still too many. It is clear that we will not achieve the goal of eliminating pediatric HIV unless we apply some serious innovations and new thinking.

Photo credit: AIDS 2012.

Key vulnerable populations face a growing epidemic

The epidemic is still growing in key vulnerable populations, including: men who have sex with men (MSM), sex workers, and injection drug users (IDUs). Participants discussed lessons learned and programming improvements to help stabilize and turn the tide on the growing HIV epidemic among MSM. For many years HIV care, treatment and prevention programming for sex workers has been less than effective. This year there seemed to be more momentum and reexamination on how we approach prevention in sex worker communities. The IDU population is perhaps still the most marginalized and difficult to reach in many countries. At AIDS 2012, we saw the beginnings of change as countries are starting to think about how to scale up national responses to reach this at-risk population.

Scott Kellerman (left) moderates a session at AIDS 2012. (Photo credit: S. Holtz/MSH)

Scott Kellerman (left) moderates a session at AIDS 2012; Erik Schouten (right), panelist. (Photo credit: S. Holtz/MSH)

Treatment is prevention

Our prevention toolkit is growing. The most promising prevention efforts currently include male medical circumcision and treatment as prevention, pre-exposure prophylaxis, with ongoing hope for further advances in microbicides and vaccines. Male medical circumcision has been shown to dramatically reduce the risk of HIV infection for men by about 60%. The HPTN 052 study that concluded last year definitively proved that initiation of antiretroviral therapy (ART) by HIV-infected individuals substantially protected their HIV-uninfected sexual partners from acquiring HIV infection, with a 96 percent reduction in risk of HIV transmission. New research presented shows that not only is treatment as prevention effective, its very cost-effective as well.

No longer do we have to qualify the term treatment as prevention, we now know that treatment is prevention. Now the hard work begins, how best to bring these innovations to scale

Tackling HIV & AIDS and chronic non-communicable diseases (NCDs)

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

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

Delegates discussed how to use the HIV & AIDS infrastructure to tackle chronic non-communicable diseases in low and middle income countries. One session, “Beyond MDG 6: HIV & NCDs” led by MSH, Pan American Health Organization (PAHO), and partners, focused on how the global health community can fight the dual epidemics by integrating health systems toward universal health coverage (UHC). In other sessions, experts noted the long neglected reality that is now upon us: with the phenomenal success of ART treatment programs, we’re now faced with an aging population of people living with HIV, and dying from tuberculosis (TB) and chronic NCDs.

Searching for a cure

Researchers released new findings at the conference, renewing a focus on finding a cure. Although all agree we’re not there yet, promising findings provide for some measure of optimism: We’re getting people on treatment; we’re getting viral loads down, maybe we can beat this.

“The science has been telling us for some time now that achieving a cure for HIV infection could be a realistic possibility,” said IAS President Françoise Barré-Sinoussi, PhD, Director of the Regulation of Retroviral Infections Unit at the Institute Pasteur in Paris. “The time is right to take the opportunity to try and develop an HIV cure – we might regret never having tried.”

Involving communities and countries for sustainability

XIX International AIDS Conference (AIDS 2012) Washington D.C. © IAS/Steve Shapiro - Commercialimage.net

XIX International AIDS Conference (AIDS 2012) Washington D.C. © IAS/Steve Shapiro – Commercialimage.net

Many presenters throughout the week reinvigorated discussions around bringing care, treatment and prevention services to the community via door-to-door testing, care, treatment and support — a not so subtle reminder that successful programs must adapt to suit the communities they serve and not the other way around. Also encouraging was the news that many countries, even those that extremely resource-limited, are contributing increasingly larger proportions of the resources to the HIV & AIDS response.

Other experts eloquently reminded us of the continued intersection of the HIV and TB epidemics, the role that social determinants of health (such as poverty) play in perpetuating the epidemic, and the unmet $7 billion funding gap needed to truly provide universal access for HIV & AIDS drugs. One session captured the unique challenges of improving HIV prevention, care and treatment in fragile states.

Kuala Lumpur & Melbourne: Looking to 2013 & 2014

Optimism filled the convention center during AIDS 2012. To be sure, challenges remain, and we have much to do to close the treatment gap and move sincerely towards elimination of pediatric HIV, but for the first time in memory, the hope that filled the halls was palpable and there was a sense that we can move forward and decrease the terrible hold that HIV has had on people these last 30 years.

As we reflect on what we learned, we also look to the future for HIV & AIDS treatment, prevention, and care. For the next two years, we look forward to being in Asia and hope to see much increased participation from our Asian colleagues. We’ll be meeting in Kuala Lumpur, Malaysia, in 2013 to discuss the scientific progress made by ourselves and our colleagues. The Kaiser Family Foundation and Center for Strategic & International Studies (CSIS) high-level panel said that key issues in Melbourne (AIDS 2014) will likely include country-level and human rights concerns, and more on the search for a cure, as well current results on implementation science and results of the HPTN052 studies.

"Turning the Tide Together" AIDS 2012.

We’re looking forward to seeing you there, and continuing this vital work together.

What was your favorite moment or lasting impression from AIDS 2012? What do you hope will be different in Kuala Lumpur (2013) or Melbourne (2014)? Tell us your thoughts below.

 

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.”

TURNING THE TIDE THROUGH INTEGRATED HEALTH SYSTEMS

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.

BUILDING ON THE SUCCESS OF HIV & AIDS PROGRAMS

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 & AIDS, C-NCDS, AND UHC

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.

Webcast: Beyond MDG 6: HIV & Chronic NCDs: Integrating Health Systems Towards Universal Health Coverage

Watch the entire session:

(Via the Kaiser Family Foundation website.)

SESSION DETAILS

While building on the momentum of the UN Summit in September 2011, this satellite recognizes that people living with HIV both treated and untreated, suffer from co-morbidities due to chronic NCDS. This satellite will examine the role of chronic NCDs and their link with HIV. More specifically, we will review lessons learned from the AIDS Decade of the 2000s and determine what lessons can be leveraged and applied beyond 2015 in the context of an emerging global burden of chronic NCDs. We will also discuss how we can use this current momentum to re-engineer the primary health care model so that it leads to sustainable, cost-efficient, comprehensive and integrated health systems that facilitate the achievement of universal health coverage for chronic NCDs in lower and middle income countries. Partners include: MSH; Government of Tanzania; Sir George Alleyne (Pan American Health Organization); AMPATH; Harvard and University of KwaZulu-Natal, South Africa.

Mildred, a mother and patient with STAR-E, Uganda

Mildred, a mother and patient with STAR-E, Uganda

Welcoming remarks

  • John Donnelly, United States
  • Dr. Jonathan Quick, United States

Why We Still Need Advocacy for Chronic NCDs Post UN-Summit, How Do We Create Shared Responsibility of This dual Epidemic and Why Here at the AIDS 2012 Conference

  • Sir George Alleyne, Barbados

What We Know About HIV Today and Its Implication Beyond 2015

  • Till Baernighausen, United States

Evidence-based service delivery models for care and treatment of persons with HIV

  • Jemima Kamano, Kenya

Leveraging Public and Private Investments in Global Health to Combat Cervical and Breast Cancer / Pink Ribbon Red Ribbon Initiative

  • Doyin Oluwole, United States

The Tanzania Model and Government Perspective on Tackling the Dual Epidemics

  • Ayoub Mmbando, United Republic of Tanzania

Join MSH: Events, Presentations, Booth 162

Cross-posted on MSH’s Global Health Impact blog.

Over 40 Management Sciences for Health (MSH) staff from around the world will join the twenty thousand health workers, activists, researchers, donors, and policy makers at the XIX International AIDS Conference, “Turning the Tide Together”. Visit us at the following events, poster and oral presentations, Booth #162, or online.

Catch live blog updates, July 22-27, and follow us on Twitter with #AIDS2012, #PMTCT, and #OptionBplus. (Kaiser Family Foundation is providing live conference webcasts.)

MSH EVENTS

Join MSH and partners at these 2012 International AIDS Conference featured events:

Beyond MDG 6: HIV and Chronic NCDs:
Integrating Health Systems Toward Universal Health Coverage

Sunday, July 22, 11:15 – 13:15, Session Room 2

  • Moderated by John Donnelly, global health journalist
  • Panelists
    • Dr. Jonathan D. Quick, Management Sciences for Health
    • Sir George Alleyne, Pan American Health Organization
    • Till Baernighausen, Harvard School of Public Health
    • Dr. Jemima Kamano, AMPATH
    • Dr. Doyin Oluwole, Pink Ribbon Red Ribbon Initiative at The George Bush Institute
    • Dr. Ayoub Magimba, Tanzania Ministry of Health and Social Welfare

Facebook event

Prevention of Vertical Transmission and Beyond:
How to Identify, Enroll, and Retain Children in Treatment Programmes in Resource-Limited Settings

Sunday, July 22, 15:45 – 17:45, Mini Room 1

  • Co-chaired by Nick Hellmann, EGPAF and IAS-ILF, and Chewe Luo, UNICEF
  • Panelists
    • Erik Schouten, Management Sciences for Health
    • Angela Mushavi, Ministry of Health Zimbabwe
    • Dorothy Mbori-Ngacha, UNICEF
    • Nandita Sugandhi, CHAI
    • Scott Kellerman, Management Sciences for Health

HIV & Health Systems Strengthening in Fragile States:
What We Don’t Know, Can Kill…What Approaches are Needed to Improve HIV Prevention, Care, and Treatment?

Thursday, July 26, 18:30 – 20:30, Session Room 5

  • Moderated by Susannah Sirkin, Physicians for Human Rights
  • Panelists:
    • Dr. Jonathan D. Quick, Management Sciences for Health
    • Amin Islam, International Rescue Committee
    • Peter Mutanda, International Rescue Committee – Kenya
    • Steve Solter, Management Sciences for Health

Special Satellite Event

Care and Treatment for People with Chronic Conditions:
What can we learn from the HIV Experience? A Health Systems Perspective

Sunday, July 22, 11:15-13:15, Session Room 8

Dr. Jonathan D. Quick, MSH President & CEO, will deliver closing remarks.

  • Sponsored by World Health Organization, UNAIDS and the Global Health Workforce Alliance
  • Co-chaired by Dr. Ariel Pablos-Méndez and Dr. Masato Mugitani, this special event features: Dr. Margaret Chan, Mr. Michel Sidibé, Paul de Lay, Dr. Sania Nishtar, Dr. Jarbas Barbosa de Silva, Jr., Dr. Milly Katana, Dr. José M. Zuniga, and Dr. Hiroki Nakatani. Moderated by Dr. Richard Horton (Editor-in-Chief, The Lancet).

MSH Affiliated Events

Voluntary Pooled Procurement of HIV/AIDS Commodities:
What Does it Take to Make VPP Achieve its Objectives and Maximize its Benefits?

Sunday, July 22, 09:00 – 11:00, Mini Room 9

  • Organized by the Grant Management Solutions Project
  • The Global Fund to Fight AIDS, Tuberculosis and Malaria established the voluntary pooled procurement (VPP) for core health products. VPP aims to increase the speed of delivery, and ensure the supply, reliability and quality of health products, secure attractive prices for them, and help strengthen local procurement and supply management capacity, states the Global Fund’s website. What hinders and what helps VPP succeed will be the topic of this panel discussion.

Global Fund Country Coordinating Mechanisms:
Providing Oversight and Leadership during the Transitional Funding Period – A Capacity Building Session

Sunday, July 22, 11:15 – 13:15, Mini Room 1

  • Organized by the Grant Management Solutions Project and The Global Fund
  • This two hour session in English is designed for CCM members, Global Fund implementers, technical support agencies, civil society and development partner constituencies involved in CCM governance and oversight. The session will focus on grant oversight for the current transitional funding period 2012-2014: 30 minutes will be devoted to presentation, 30 minutes to Q&A and 1 hour to smaller group work using case studies to train on analyzing and solving problems of oversight and prioritization. These sessions will address the core challenge of the 2012-2014 period for GF beneficiary countries – how to successfully steward their grants so as to maintain patient coverage and access to quality services. A French session will be held at this time in Session Room 9.

Supply and Demand of HIV/AIDS Commodities:
Can the Global Market and National Supply Chains Support Continued Rapid Scale Up of HIV/AIDS Treatment?

Thursday, July 26, 18:30 – 20:30, Mini Room 2

  • Organized by The Partnership for Supply Chain Management and USAID Global Health Bureau Office of HIV/AIDS
  • The international community has agreed to a goal of universal access by 2015. If donors increase funding to provide treatment to 15 million, can a sufficient volume of ARVs and other commodities be manufactured and distributed in target countries? Will national supply chains be able to receive and distribute many times the current volumes? Participants will learn about the integrated nature of global supply chains to meet public health needs, and discuss obstacles in the global supply chain to meeting the goal of access to HIV/AIDS treatment.

Visit us at Booth #162

More information on:

  • Prevention of Mother-to-Child Transmission (PMTCT) and Option B+ (Sunday & Wednesday)
  • Health Systems Strengthening (Monday & Thursday)
  • Pharmaceutical Management (Tuesday)

Follow live conference updates

See you in DC or online, “turning the tide together”!