High-level ICAP Meeting in Bellagio Addresses Impact of HIV Program Scale-Up on Health Systems in Africa

September 8, 2008

NEW YORK, NY – In a high-level meeting Sept. 2-5 at the Rockefeller Foundation Bellagio Center in Italy, an international group of public health leaders examined the effects of the scale-up of HIV programs on fragile health systems and identified ways that these programs can be leveraged to strengthen health systems, particularly in resource-limited countries in Africa. The meeting, part of a larger initiative to address this issue, was attended by experts from international technical and donor agencies, program developers and implementers, and health system analysts. It was sponsored by the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University’s Mailman School of Public Health and supported by the Rockefeller Foundation.

In recent years, the dramatic infusion of resources for the scale-up of HIV programs has provided critical treatment and prevention services for millions of people in resource-limited countries. While these programs have clearly benefitted recipients of these services, some have raised concerns that HIV programs may not have addressed key deficiencies in health systems or may have diverted resources from other health threats. Others suggest that investment in HIV programs has served broader health system needs by benefitting clinical infrastructure, laboratory capacity, integrated services, skills building of health care workers, and data management systems.

At the Bellagio meeting, participants acknowledged the lack of rigorous data on the effects of HIV scale up on health systems and identified the need to focus research in this area in order to develop evidence-based conclusions and inform future program design. Participants discussed potential research questions and reached a consensus on a prioritized research agenda for addressing them. They also shared lessons learned and best practices regarding the impact of HIV-specific programs on broader health services.

“In recent years, there has been much heightened interest in the impact of disease-specific programming on health systems, but limited data exists to understand these effects,” said ICAP Director Wafaa El-Sadr, MD, professor of clinical medicine and epidemiology at Columbia University. “The Bellagio meeting built a platform for moving forward with research studies and planning future initiatives related to this important issue.”

In addition to El-Sadr, attendees included: Elaine Abrams, MD, director of ICAP’s MTCT-Plus Initiative and professor of pediatrics and epidemiology at the Columbia University College of Physicians and Surgeons and the Mailman School of Public Health; Pedro Cahn, MD, president of the Huésped Foundation in Argentina; Hoosen Coovadia, MBBS, MD, Victor Daitz Professor for HIV/AIDS Research at the University of Natal, South Africa; Kevin De Cock, MD, director of the World Health Organization (WHO) Department of HIV/AIDS; Ambassador Mark Dybul, MD, U.S. Global AIDS Coordinator; Seble Frehywot, MD, assistant research professor of health policy and global health at the George Washington University; David Hotchkiss, PhD, health economist and demographer at Tulane University; Michael Isbell, JD, independent consultant and former member of the Presidential Advisory Council on HIV/AIDS; Ruth Levine, PhD, vice president for programs and operations at the Center for Global Development in Washington, DC; Zenebe Melaku, MD, country director for ICAP Ethiopia; Jonathan Mermin, MD, director of the U.S. Centers for Disease Control and Prevention program in Kenya; Peter Mugyenyi, MD, executive director of the Joint Clinical Research Centre in Uganda; Joia Mukherjee, MD, medical director of Partners in Health in Boston, MA; Jos Perriens, MD/PhD, coordinator for the WHO’s Strengthening Systems for HIV (SSH); Miriam Rabkin, MD, ICAP director for development and associate clinical professor of medicine and epidemiology at Columbia University; Badara Samb, MD, PhD, advisor to WHO’s assistant director-general, health systems and services; Nelson Sewankambo, MD, professor of medicine, dean of the faculty of medicine, and chair of the board of the Infectious Diseases Institute at Makerere University, Uganda; Moses Sinkala, MD, Zambia country director for the Catholic Medical Mission Board; Diana Weil, MSc, coordinator of policy and strategy for the WHO’s Stop TB Department; and Debrework Zewdie, PhD, director of the World Bank’s Global HIV/AIDS Program.

About ICAP
ICAP is a global leader in supporting the scale-up of multidisciplinary HIV/AIDS prevention, care, and treatment programs based on a family-focused approach. Currently, ICAP supports programs in 14 resource-limited countries of sub-Saharan Africa and Asia which provide HIV services to more than half a million people, including antiretroviral treatment to nearly 238,000 individuals. In addition, ICAP-supported sites have provided HIV counseling and testing services to more than 317,000 pregnant women. For more information, visit the ICAP website at www.columbia-icap.org.