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.

No Silver Bullet: HIV & AIDS Challenges and Solutions

Dr Nelly Mugo, AIDS 2012

XIX International AIDS Conference (AIDS 2012) Washington, DC. Dr. Nelly Mugo, Kenya © IAS/Steve Shapiro -Commercialimage.net

Tuesday’s (July 24) session at the XIX International AIDS Conference kicked off with a plenary session on HIV & AIDS “Challenges and Solutions”.

The first three presenters, Javier Martinez-Picado (Spain) from the AIDS Research Institute IrsiCaixa and ICREA; Dr. Nelly Mugo (Kenya) of the University of Nairobi and Kenyatta National Hospital; and Dr. Bernhard Schwartländer, (Switzerland) the Director for Evidence, Innovation and Policy at UNAIDS, each spoke about the possibilities for ending AIDS. Dr. Howard Koh, Assistant Secretary for Health for the US Department of Health and Human Services described US efforts to end AIDS.

A cure or eradication is necessary

Dr. Martinez-Picado launched the session with a list of reminders why a cure or eradication is necessary: (1) The HIV virus is suppressed with antiretroviral therapy (ART), and (2) the vast majority of patients who adhere to treatment will live long, healthy lives. However, (3) mortality and morbidity from chronic diseases such as heart disease and cancer is still higher in populations of HIV-positive patients in treatment than in the general population. In addition, (4) stigma and discrimination against people living with HIV continues to plague nearly every community. And (5) the cost of treatment is projected at $22 billion per year for universal access. For all of these reasons, a cure or eradication is preferable to lifelong treatment.

This cure or eradication will require, “a prolonged period of research,” said Martinez-Picado. But he urged the audience not to let that deter our efforts. He presented a series of scientific studies that are showing varying signs of promise for progress toward a cure. Though none of them is a silver bullet, it is clear that progress is being made in HIV science.

Science, Not the Only Answer

Science isn’t the only answer — though an important one — Dr. Nelly Mugo reminded us in her presentation. According to Dr. Mugo, 44 percent of new HIV infections in Kenya are among married or cohabitating couples, and 50 percent of HIV-positive couples are serodiscordant. Often a couple’s desire for children will overshadow their fear of transmitting the virus to their partner, thus preexposure prophylaxis and treatment as prevention are important strategies for keeping partners of people living with HIV free of the disease.

However, adherence to treatment and linking patients with care after testing are still major problems — not only in Kenya, but worldwide. The solution to these problems is not more advances in science, but rather community-based efforts to make sure both HIV-positive clients and their partners understand the necessity of accessing treatment and adhering to it for life. After all, treatment as prevention cannot work if treatment is not accessed.

Another $7 Billion

Neither science, nor social programming is free. And without increased funding, the number of new HIV infections per year will stagnate, said Dr. Bernhard Schwartländer. Though he believes we must “learn how to do more with what we have,” Dr. Schwartländer also urged countries to take ownership of their health and increase domestic funding for health, including HIV services. Though he believes another $7 billion is needed by 2015 in order to halve the rate of new HIV infections, he says that if low- and middle-income countries continue to fund health services at the same rate they are currently funding them, the gap will be closed as these nations emerge from low-income to middle- and high-income status over the next decade.

“None of this will be achieved without a strong activist voice,” Dr. Schwartländer reminded the crowd, and urged us to challenge our governments to rise to the challenge. “The world overall is getting richer,” he said, “We have to make it fairer.”

Dr. Howard Koh presented achievements made during the first two years of implementation of the United States’ HIV and AIDS strategy. He praised the FDA’s recent approval of Truvada for pre-exposure prophylaxis and the provisions the Affordable Care Act will make for HIV care — including ending insurance companies’ ability to cap lifetime care limits and preexisting condition exclusions. The US plans to decrease the number of new infections within our borders by 25 percent by 2015 through cutting-edge research on vaccines and microbicides and increasing the number of people who know their status through innovative programs, such as free HIV testing at the department of motor vehicles.

It is clear from this session that we will not end AIDS tomorrow. But with the vision of our leaders, the voices of our activists, and the hard work of those on the front lines living and working with people living with HIV a future free of HIV is within our reach.

Mary Burket is communications manager in MSH’s Center for Health Services.

Monday at Booth 162: Strengthening Health Systems to Eliminate HIV & AIDS

Stop by MSH booth 162 today, Monday, July 23 to say hello, and pick up MSH materials about strengthening health systems to eliminate HIV & AIDS. Booth hours: 10:00 – 18:30 today.

We are the health system!

See you at booth 162!

Up next (tomorrow): Managing pharmaceuticals

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”!