Seven strategies for smarter HIV programmes

Speaking at the International AIDS Conference earlier this week, former US President Bill Clinton told delegates that the credit crunch meant HIV programmes would need to work “faster, better and cheaper”.



IRIN/PlusNews has put together a list of ways HIV service providers could cut costs and improve their efficiency:



Task-shifting - The allocation of tasks traditionally performed by doctors and nurses to less qualified staff has already seen positive results in Ethiopia, Malawi and Mozambique.



There will be a need to carefully monitor task-shifting programmes and ensure proper training of health workers, as some studies have found that insufficiently trained medical staff can be harmful to national antiretroviral (ARV) programmes.



Community support - Community mobilization has already played a significant role in HIV education and care in many poor countries where relatives and neighbours often help to monitor patients and raise awareness about HIV. Research has found that community support improves adherence to ARV medication and that involving people living with HIV to serve as community health workers can cut costs and reduce stigma.



Cheaper drugs - The cost of combination ARV therapy has come down significantly from about US$10,000 per person per year in 2000 to about $88 a year. The Clinton Health Access Initiative, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the international funding mechanism, UNITAID, have all contributed significantly to negotiating with pharmaceutical companies to lower drug prices.



However, the second- and third-line ARVs that are needed by increasing numbers of patients who have developed resistance to first-line drugs are still prohibitively expensive for low income countries. A recently created patent pool will be central to persuading big pharmaceutical companies to allow generics manufacturers to use their patents to produce such drugs more cheaply.



Simpler drug delivery systems - Also speaking at the AIDS Conference, Bernhard Schwartlander, UNAIDS director for evidence, strategy and results, noted that between two-thirds and 80 percent of money spent on HIV is not drug-related - it is related to service delivery, patient monitoring, and laboratory costs.



More efficient drug procurement and supply chains would go a long way towards making programmes more cost-effective and efficient. In Uganda, for instance, supply chain woes have left people without drugs, in some instances because ARVs were allowed to expire before being dispensed.



Using technology - SMS-based check-ups (using text messages sent from cell phones) are saving patients in Kenya the cost of travelling to a clinic every month, while a multi-country campaign in Africa is using cell phone technology to track stock-outs of essential medicines in government facilities.



Country ownership - Done properly, shifting the management of HIV programmes from foreign donors and NGOs to national governments would reduce administrative costs while giving locals the skills to sustain programmes. PEPFAR is already transferring the management of its programmes from the US Agency for International Development to local governments.



Fighting government graft will, however, be key to the success of country-run HIV programmes. Concerns over corruption have, for example, led the Global Fund to Fight AIDS, Tuberculosis and Malaria to cancel or suspend its funding to several countries.



Health system integration - Large investments in HIV have been criticized for drawing money and human resources away from under-funded national health systems.



Today, the global health community seems in agreement that integrating HIV into strengthened national health systems is a good idea. HIV service providers are being urged to work with other health services so that all sectors of the health system can benefit. In Haiti, for instance, voluntary counselling and testing services are providing a useful entry point for reaching women in need of sexual and reproductive health services.



See also: GLOBAL: Time to start doing more with less money



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