For the past several days, US government officials have held internal meetings (called here “USG-only’’), but today the conference expands for the next four days with dozens of presentations involving AIDS experts from many groups.
This is my fourth implementers’ conference, and I’ve found the meetings I’ve attended before (Addis Ababa, Durban, and Kampala) to be critical in learning what is happening on the ground at that particular moment in Africa, and to a lesser degree Asia and Latin America. These gatherings are dominated by the biggest player in the field – the US President’s Emergency Plan for AIDS Relief, or PEPFAR.
Already, many hours before the opening ceremony, the place is buzzing with one overriding issue: Funding the response in a tough economic climate.
The biggest bit of news came from a report released earlier this week in Washington that showed if AIDS treatment programs started patients earlier on antiretroviral medicines – beginning at 350 CD4 count, instead of the current 200 CD4 count – not only do the patients recover much more quickly but tuberculosis mortality also substantially decreases.
In a couple of months, the World Health Organization is expected to weigh in with its recommendations of when countries should start antiretroviral treatment for patients. If it recommends starting treatment when a patient has a 350 CD4 count or lower, that will greatly expand the pool of people who need treatment – and not by a few thousand. The number could be in the several million range, according to estimates discussed here. (Now, PEPFAR helps treat roughly 2.4 million people in its 15 focus countries.)
The problem: Donors and developing country governments are in various degrees of budgetary crisis. The Obama administration’s new $63 billion six-year global health plan calls for just a $100 million increase in the PEPFAR budget for next year. (See this analysis on the Obama plan.) Congress will take up the funding request in the next month or so.
With a 350 CD4 count trigger for treatment, those eligible for treatment in South Africa could more than triple, according to an estimate based on modeling that was presented in one of the USG-only meetings. The estimate for Kenya: those eligible for treatment could double. To put that in perspective, South Africa now has roughly 600,000 on treatment; if the estimates are anywhere near accurate, it alone could have more than 1.2 additional people eligible for treatment.
Still, that doesn’t mean all those people will ask for treatment. The majority of those eligible still don’t know their status. Experts here estimate that by starting treatment at 350 CD4 level, it could immediately add 20 percent more to those seeking treatment. The cost would be significant.
With so many other demands on funding – expansion of prevention programs (male circumcision, prevention of mother-to-child transmission, to name two), battling HIV/TB co-infection – the welcome news from the study also sent shivers through those who put together the PEPFAR budgets.