Africa: U.S. Effort Created 'Remarkable Expansion' in Aids Treatment

Washington — The 10-year U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has led to a "remarkable expansion" in services for people living with HIV/AIDS worldwide, according to a report released February 20.

The findings of an Institute of Medicine (IOM) study panel noted that the campaign has "met or surpassed" many of its goals to expand treatment to people living with HIV, give care to those with AIDS and provide prevention options to those at risk of infection.

PEPFAR is striving to reach 6 million people with HIV antiretroviral treatment (ART), while the current scope of the program reaches some 5 million persons with the lifesaving medications.

Panel members announced their conclusions at a briefing held at the National Academy of Sciences, IOM's parent institution, in Washington. Panel member Jennifer Kates said PEPFAR's efforts to care for people with AIDS and their dependents are exceeding the goals.

The program target is to reach 12 million people with care services, Kates said, while PEPFAR is now "supporting care for nearly 15 million, including more than 4.5 million" orphans and vulnerable children.

The care of children -- hundreds of thousands orphaned after their parents died of AIDS -- was an urgent priority when the program began in 2003, and PEPFAR has "provided unprecedented support" for that vulnerable group in subsequent years.

Conceived during the administration of President George W. Bush, PEPFAR was the largest effort ever made by a government to address a single health problem. The concept was new and untested, but the IOM report validates the approach and the results it has achieved: millions of lives saved and improved.

"I think essential to those working in HIV, [PEPFAR has] provided proof of principle that you can do this," said Kates. "You can successfully scale up a large program in countries with high disease burden."

Significant doubt existed in the early years of the last decade that such an endeavor was possible, Kates said. PEPFAR began in 2003 as a $15 billion program, but U.S. investments in AIDS relief have now grown to more than $37 billion in bilateral aid. The United States has also donated more than $7 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

"We are proud that the IOM stated that PEPFAR has played a transformative role in the global response to HIV," said Eric Goosby, the U.S. global AIDS coordinator who oversees PEPFAR. "We stand ready to continue to play this role as we work with our partners across the globe to create an AIDS-free generation."

The Obama administration announced its intent on World AIDS Day 2012 to work toward an AIDS-free generation, a strategy based in part on more effective prevention methods.

"That's the only way to get ahead of this epidemic," said Ann Kurth, a committee member from the New York University College of Nursing. An AIDS-free generation can only be achieved when prevention efforts are so expansive that new infections are minimal and are exceeded by the number of new people receiving ART therapy.

The IOM committee worked four years to develop the report, which is about 700 pages long. Panel members conducted more than 400 interviews with people working in PEPFAR activities and made trips to 13 countries in South America, Africa and Asia to study implementation of the programs in stricken regions.

PEPFAR was evolving while the study was in the making, so a number of actions it recommends are already being undertaken. Long-term success in keeping disease at bay, the report says, will depend on countries making a transition. Rather than recipients of emergency assistance, they must become stewards of health care systems that routinely provide the services of treatment, care and prevention.

A report summary indicates that process is well under way. "Already PEPFAR has improved the function of health systems. It has strengthened laboratories [and] bolstered the reliability of supplies and essential medicines."

The training of hundreds of thousands of health care workers achieved under PEPFAR is another step in this direction, the report says.

Now that the urgency of the AIDS crisis has ebbed slightly, Kurth said, countries receiving PEPFAR assistance must place a greater focus on outcomes, such as reducing infections, reducing deaths, helping patients adhere to a care routine and increasing access to HIV testing.

"While our work is far from finished," according to Goosby, "we believe our best days lie ahead as we work with the global community to help countries reach the tipping point in their epidemics, and sustain their AIDS responses over time."

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