USIS Washington File - July 7, 2008
Cheryl Pellerin, Staff Writer

"Implementers" are those engaged in bringing information and services to people affected by the HIV/AIDS epidemic. They include representatives from community- and faith-based organizations, nongovernmental organizations, governments and ministries, international partners, organizations of people living with HIV/AIDS, service providers and provider networks, academia and the private sector.

"We have done very well in treatment, we have done fairly well in care although we have a long way to go," Ambassador Mark Dybul, coordinator of the President's Emergency Plan for AIDS Relief (PEPFAR), said during a July 1 briefing, "but there is real recognition that we are trailing scientifically and in implementation in terms of prevention. Every speaker, every head of organization emphasized the need to focus on prevention."

The Ugandan government hosted the five-day meeting in Kampala. The theme of this second annual implementers' meeting was "Scaling Up Through Partnerships: Overcoming Obstacles to Implementation." It built on the first meeting held in Kigali, Rwanda, in 2007.

Cosponsors were PEPFAR; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Joint United Nations Program on HIV/AIDS (UNAIDS); UNICEF; the World Bank; the World Health Organization (WHO); and the Global Network of People Living with HIV/AIDS. (See "Best Practices to Fight HIV/AIDS Is Focus of Uganda Meeting.")

ON THE GROUND

According to the latest estimates from UNAIDS and WHO, the number of people living with HIV/AIDS globally rose from 29 million in 2001 to 33.2 million in 2007. Annual deaths increased from 1.7 million in 2001 to 2.1 million in 2007 but have declined recently, partly because more people are receiving antiretroviral treatment.

New HIV infections peaked in the late 1990s declined between 2001 and 2007 from 3.2 million to 2.5 million because of natural trends in the epidemic and prevention efforts. In 2007, 6,800 people a day were newly infected with HIV.

At the meeting in Kampala, more than 1,600 implementers from 68 countries gathered to hear 110 invited speakers and to share their successes and challenges. From 1,600 abstracts describing a range of programs, 391 were accepted for oral presentations during the meeting and 144 for poster presentations.

The meeting's success, said J. Stephen Morrison, executive director of the Center for Strategic and International Studies Task Force on HIV/AIDS, "reflects the emerging power and voice of the implementers who are on the ground in the focal countries and beyond, and the fact that their knowledge and experience is becoming so vital."

The PEPFAR focus countries -- those hardest hit by HIV/AIDS -- are Botswana, Ethiopia, C|te d'Ivoire, Guyana, Mozambique, Kenya, Nigeria, Haiti, Namibia, Rwanda, Vietnam, South Africa, Tanzania, Zambia and Uganda.

NEW APPROACHES

Common themes during the many plenary sessions, panels and breakout sessions included getting more people into treatment and care, keeping people in treatment and care, and ensuring quality services. A range of public and private partners joined forces to address community needs.

In Eastern Africa, Makerere University and the U.S. Military HIV Research Program at Walter Reed Army Medical Center teamed up in 2007 to identify hard-to-reach HIV-positive people at four rural clinics during regular health visits. Health workers were trained in the use of an HIV rapid test, counseling and routine testing and counseling policy. Today, the program is increasing the number of referrals to HIV clinics.

Tuberculosis (TB) is the leading cause of death in HIV-infected people globally, and a partnership between the Thailand Ministry of Health and the U.S. Centers for Disease Control and Prevention helped develop a province-level TB laboratory network in Thailand, which has a high burden of TB and a generalized HIV epidemic. The partners developed standardized indicators to routinely monitor the performance of culture and drug-susceptibility testing and maintain laboratory quality.

One of the best practices that arose from the meeting is called task shifting. A major constraint to tackling HIV/AIDS and global access to essential health care services is a serious shortage of health workers. At least 57 countries have a crisis-level shortage of health workers, according to WHO, and 36 of those are in Africa.

Task shifting involves delegating some tasks to less specialized health workers. By reorganizing the workforce, task shifting offers a workable way to improve health care coverage by making more efficient use of the human resources already available.

"One hour of a prescribing nurse's time saved a doctor 45 minutes," said Dr. Caroline Ryan, director of program services in the Office of the U.S. Global AIDS Coordinator. "So it freed up time for the physicians to be involved in other consultations."

Several countries already use task shifting to strengthen their health systems and scale up access to HIV/AIDS treatment and care. WHO, PEPFAR and UNAIDS are working to develop global guidelines for task shifting.

"Task shifting was part of the response to the health care workforce crisis and it's part of the long-term solution," she added, "but more clinical and nonclinical staff need to be added."

More information about the implementers' meeting is available on the meeting Web site.

More information about PEPFAR is available at that organization's Web site.

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