Wafaa El- Sadr, MD, from the International Center for AIDS Programs at Columbia University, and Professor Rifat Atun from the Global Fund opened an important 2-day meeting on HIV and health systems strengthening. They made key remarks that both challenged the notion of HIV programs as a singular intervention for a single disease, while suggesting that the debate about “horizontal versus vertical” programs is taking place in a vacuum that does not account for the reality of these programs on the ground.
Atun noted that the evidence base for real comparisons of horizontal or integrated programs versus vertical programs is a weak one. A comprehensive review found only 12 studies on the subject, with only three of them focused in developing countries.
El-Sadr offered a litany of broader impacts of the global HIV response from documented reductions in all cause mortality in countries, to specific impacts on mortality for children under 2 years old.
The mixed audience of HIV and health systems specialists worked to find common language and common ground as they identified research questions, data needs and programmatic challenges.
A panel with representatives from PEPFAR , the Global Fund and UNAIDS closed the meeting highlighting some key summary issues and next steps. Eric Goosby, MD, U.S. Global AIDS Coordinator, raised themes he has mentioned frequently as of late. He identified the bottom line as “saving more lives” and indicated that the next phase of the AIDS effort would be best “convened by country leadership.”
“Countries may not always engage, but must always be engaged,” Goosby said. He suggested that donors must work with countries to increase accountability for and management of outcomes. He asserted that donors can no longer afford to engage in parallel processes at the country level to maximize the use of resources in the context of these challenging fiscal times.
Deputy Director of UNAIDS Paul DeLay indicated that UNAIDS Director Michel Sidebe was committed to rethinking the role of UNAIDS “and taking AIDS out of isolation.” He also said that scale up of treatment has been relatively linear for the past four years and there is no way we will reach treatment or prevention goals on the current trajectory. He called for radical re-thinking about the way we deliver treatment to facilitate scale-up.
Finally, Elly Katibara, the President-elect of the International AIDS Society and an HIV clinician in Uganda for the past 25 years, called the representatives from PEPFAR, UNAIDS and the Global Fund “giants who will be responsible for my failure or success” in continuing to treat patients. He pointed out that for most of his tenure as an HIV clinician, he had been treating patients with “his bare hands.” He also pointed out that his position in taking over the presidency of IAS next week from Julio Montaner, MD, was quite different since Dr. Montaner was able to place any patient of his on HIV treatment.