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Scale-up of HIV Programs: A Platform for the Global Health Response Wafaa El-Sadr, MD, MPH

Scale-up of HIV Programs: A Platform for the Global Health Response Wafaa El-Sadr, MD, MPH Harlem Hospital & Columbia University. HIV Prevalence. www.worldmapper.org. Characteristics of HIV that drive program design.

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Scale-up of HIV Programs: A Platform for the Global Health Response Wafaa El-Sadr, MD, MPH

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  1. Scale-up of HIV Programs: A Platform for the Global Health Response Wafaa El-Sadr, MD, MPH Harlem Hospital & Columbia University

  2. HIV Prevalence www.worldmapper.org

  3. Characteristics of HIV that drive program design

  4. Number of people receiving antiretroviral therapy in low- & middle-income countries, by region, 2002–2008 WHO, Towards Universal Access, 2009

  5. HIV prevalence & Performance of Health Systems UNAIDS 2009 WHO 2000

  6. A Healthcare System in Crisis

  7. Increased antiretroviral therapy coverage and decrease in all-cause mortality South Africa, 2003–2006 WHO, Towards Universal Access, 2009

  8. Estimated number of AIDS-related deaths with and without antiretroviral therapy, globally, 1996–2008 3.0 2.5 2.0 Number (millions) 1.5 1.0 0.5 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year No antiretroviral therapy At current levels of antiretroviral prophylaxis 2.9 M lives saved UNAIDS 2009 AIDS Epidemic Update

  9. Support for Systems

  10. Mosaic of Services

  11. Health System Framework

  12. Health System Components and Elements of HIV Scale-up

  13. Framework:HIV programs touch each “building block” of the health system

  14. Vertical Funding TARGETS & Outcomes Horizontal Implementation

  15. What about other health threats?Mortality Rates in Adults in Africa

  16. Disproportionate Disease Burden Land Mass HIV Prevalence 15-49 years Tuberculosis Cases Childhood Diarrhea Malaria Deaths www.worldmapper.org 2006

  17. Synergies TB diagnostics Early TB diagnosis ART for TB prevention & improved TB outcomes Use ofIPT Adherence & outreach Infection control Maternal follow-up Antenatal care Postnatal care Male involvement Safe motherhood Maternal mortality Child follow-up Maternal follow-up

  18. Integration of TB/HIV Programs and Services Traditional TB and HIV Paradigm New TB/HIV Paradigm National HIV Program National TB Program National TB Program National HIV Program Communication • TB Services • Sputum collection • DOT • Contact tracing • IPT • HIV Services • C&T • CPT • ART • OI Dx & Tx • Adherence • support • PWP Integration of Services

  19. What about other health threats?Mortality Rates in Adults in Africa

  20. Commonalities of Barriers and Challenges HIV/AIDS Barriers and challenges Maternal health Child health Diabetes TB • Demand-side barriers • Inequitable availability • Human resources • Lack of adherence support • Infrastructure, equipment • Program management • Drug supply / procurement • Referral and linkages • Community involvement √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ Adapted from Travis, Bennett, et al. Lancet 2004

  21. . Millennium Development Goals (MDGs) MDG-1: to eradicate extreme poverty and hunger; MDG-2: to achieve universal primary education; MDG-3: to promote gender equality and empower women; MDG-4: to reduce child mortality; MDG-5: to improve maternal health; MDG-6: to combat HIV/AIDS, malaria, and other diseases; MDG-7: to ensure environmental sustainability; and MDG-8: to develop a global partnership for development

  22. Push versus Pull Strategy? Push Strategy Pull Strategy Investment in Health Systems Investment in HIV Programs

  23. Health System Framework

  24. Systems Thinking for Health Systems Strengthening, AHPSR/WHO 2009

  25. Synergies

  26. Conclusions • Significant achievements in HIV program scale-up– but much more needs to be done • Treatment available for only 40% of those in urgent need • Prevention available to 1 in 5 individuals • HIV scale-up is a remarkable results-oriented global assistance program • achieving meaningful outcomes • transforming health systems • enabling broad-based benefits

  27. The HIV/AIDS Emergency is Not Over • Unfinished Business • Remarkable Opportunities Thank you

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