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AIDS: Getting the best value for money

Thomson Reuters Foundation - Thu, 1 Dec 2011 01:01 GMT
Author: Stefano Bertozzi, Bill & Melinda Gates Foundation
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Stefano Bertozzi is director of the HIV/TB Programme at the Bill & Melinda Gates Foundation. The opinions expressed are his own.

World AIDS Day provides us an annual occasion to pause, reflect, and take stock of how we are doing in the fight against HIV.

This year strikes me as especially noteworthy, and not just because of the well-documented breakthroughs and heartbreaks in HIV prevention research.

This year, we can celebrate the fact that the world is becoming smarter about how it spends its limited HIV-related financial resources.

Innovative cost-saving strategies and partnerships are allowing us to reach more people with HIV prevention, treatment and care, even amid flat or declining budgets.

Why is this critically important?

Today, in low-income countries only half of people in need of treatment are actually receiving it. Maximizing efficiencies across the board will help to create a more equitable global health system, especially for those living with HIV in the poorest communities of the world.

We’ve made incredible progress in the past 18 months, since Bill Clinton and Bill Gates highlighted the need to maximize our resources and achieve efficiencies of scale and delivery at the International AIDS Society conference in Vienna.

Let me cite three examples—coordinated drug procurement, decentralized treatment delivery, and task shifting for male circumcision. Together, these strategies are changing the future of the AIDS pandemic and providing examples of how to address other global health challenges.

On procurement, the Clinton Health Access Initiative (CHAI) recently negotiated major price reductions on key antiretroviral drugs. Now, 70 countries have access to antiretroviral therapy priced 16 to 20 percent lower than the average price paid in 2008. Every dollar or euro saved translates directly into more people receiving lifesaving treatment.

Regarding drug delivery, South Africa is pioneering new models of decentralized, nurse-provided ARV treatment. This allows the country to treat more people, closer to their homes and for less money.

Lastly, through task shifting or more efficient staffing, Kenya has significantly cut the cost of male circumcision to $39 per procedure from $65 three years ago.

Highly trained nurses or physicians perform jobs once done by surgeons, and new devices may allow even lower-level providers to perform the procedure safely and effectively. Male circumcision is one of the few public health interventions that is so effective and so inexpensive that it actually saves money when countries scale it up.

Just as HIV/AIDS ushered in a new era of global health equity, so too has it been an example of how to get the best value for money.

Using the HIV model, CHAI has turned its attention to reducing prices for vaccines and TB and malaria drugs. Task shifting and decentralized drug delivery are being applied to such fields as reproductive and maternal and child health.

While these creative solutions are stretching resources and buying us time, we cannot depend upon ever-increasing levels of efficiency. Eventually, donors will need to ramp up overseas development assistance or leave millions to die of HIV.

We’re also keenly aware that we’ll never end the epidemic with existing tools alone. That’s why the foundation’s number one AIDS priority continues to be the development of a safe, effective and affordable HIV vaccine.

In the meantime, let us redouble our efforts to use currently available combination prevention to create an AIDS-free generation.

This blog is cross-posted at

AlertNet Special Coverage: World AIDS Day 2011

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