Investment in HIV Programs Can Transform Health Systems in Resource-limited Countries, Argue ICAP Leaders

November 26, 2007-- Unprecedented investment in the scale-up of HIV care and treatment has provided anti-HIV treatment to nearly a million people in resource-limited countries. Some, however, have expressed concern that this investment is diverting limited human and financial resources from other health programs in these countries. In a commentary in the October edition of the journal AIDS, Drs. Wafaa El-Sadr and Elaine Abrams of the International Center for AIDS Care and Treatment Programs (ICAP) at the Columbia University Mailman School of Public Health argue instead that investment in HIV programming has the potential to transform health care systems in resource-limited countries into more effective and responsive systems capable of meeting broader health needs.

El-Sadr and Abrams base their analyses on ICAP’s work in support of the expansion of HIV prevention, care, and treatment in 14 sub-Saharan African countries. ICAP collaborates with in-country partners to provide broad support for infrastructure development and capacity building. In the commentary, the authors suggest that the scale-up of HIV programs in countries such as where ICAP works will have a broader positive impact on health systems because of enhancements made to clinical and other health system infrastructure; greater attention paid to the roles and needs of healthcare workers; and the model of care necessitated by the characteristics of HIV disease.

The authors describe how ongoing infrastructure improvements funded by HIV programming, including renovations of health facilities and laboratories, relieves severe congestion at these facilities and results in appropriate clinic designs that support patient confidentiality. Newly renovated and equipped laboratories support the care of all patients, not only those with HIV infection. In addition, new support for the healthcare workforce, which has traditionally been underfunded and understaffed, combined with extensive HIV training and mentoring for all cadres of health workers, may lead to improvement in retention of healthcare workers in resource-limited countries.

Due to the chronic nature of HIV, El-Sadr and Abrams contend that the culture of healthcare services in resource-limited countries has evolved to one that is patient-centered and focused on long-term follow-up, rather than one that is episodic and curative in nature. With additional staffing and other resources, systems developed for HIV can be adapted to manage other chronic diseases and conditions, such as hypertension, diabetes and mental illness.

El-Sadr and Abrams point to programs for the prevention of mother-to-child transmission (PMTCT) of HIV as examples of how HIV services can have a broader impact on health services. ICAP-supported PMTCT programs are typically integrated with antenatal and maternal child health services. Enhancement of these latter programs will likely result in favorable outcomes for all women and children that utilize these services.

El-Sadr and Abrams caution that HIV programs must be designed and implemented with the additional goal of achieving broader health benefits. They also emphasize that innovative monitoring and evaluation frameworks must be applied to measure the effects of HIV programs on broader health indices.