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GHF2006 – PS17 Challenges in Long-Term Drug Delivery (HIV & TB)

Session Outline

Parallel session, Friday, September 1 2006, 11:00-12:30
Chair(s): Bernard Hirschel, Switzerland, Alexandra Calmy, Switzerland
Sustainable Financing and HIV, Malaria, TB Control
Michel Kazatchkine, Ambassador on HIV/AIDS and Transmissible Diseases; Director, National Agency for Research on AIDS, Paris, France 
Long-Term Challenges for ARV Programmes on the African Continent: Experience from Southern Africa 
Eric Goemaere, Médecins sans frontières (MSF) South Africa, Head of Mission, Cape Town, South Africa
The New Stop TB Strategy
Mario Raviglione, Stop TB Department, World Health Organization, Geneva, Switzerland 

Session Documents

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Session Report

Submitted by: Elise Magnenat (ICVolunteers); Contributors: Martin Elling (ICVolunteers), Milena Lawrence-Samuel (ICVolunteers), Tatjana Schwabe (ICVolunteers)
"TB control is a marathon, not a sprint!" Image: Viola Krebs,

The three speakers of this session all emphasized the increasing negative impact of diseases like HIV/AIDS, tuberculosis (TB) and malaria on economic and social development in the world today. As Mr. Kazatchkine said: "The health sector [...] was originally seen as a non-profitable source of expenditure, is now considered as a factor and a necessary investment for development". Indeed, the benefits of preventing and treating HIV/AIDS, TB and malaria outweigh the costs caused by such diseases. Other topics discussed included sources of funding for treatment and prevention of these diseases, as well as problems in providing efficient health care for victims in the developing world.

Mr. Michel Kazatchkine, the French Ambassador for HIV/AIDS and Transmissible Diseases and the Director of the National Agency for Research on AIDS in France opened the symposium by reminding the audience that HIV, TB and malaria are "by far the leading causes of ill-health and premature death in Africa". Their impact on development had led to a shift in perception of health. Whereas formerly, health was seen as a consequence of development, it is today considered as a factor of economic growth. This observation has become particularly evident with AIDS which has been a catalyst to bring link between poverty and access to health on international agenda. Mr. Kazatchkine insisted that it was essential to shift financing from an emergency mode to building sustainability by drawing on national resources of affected countries as well as external funding. In the latter category, Official Development Aid (ODA) clearly represents the most important contribution, with a significant increase over the last years. However, the increase of money addressed to the health sector has been smaller compared to education or governance, although the number of people affected by disease is increasing and treatments, which need to evolve with the target disease, become more and more costly. Sustainability is also difficult to achieve because governments contribution to ODA is based on their national budget and changes yearly. Another source of external funding is what Mr. Kazatchkine called "Innovative sources of funding" such as debt conversion or the International Finance Facility for Immunisation (IFFIM), proposed by the International Financing Facility (IFF). He went on to present in more in detail the air ticket levy to fund the purchase of drugs against AIDS, Malaria and TB, introduced by five countries including France since July 2006. This new tax was instigated to raise money from people who benefit from globalization and to redistribute it to people who do not. The funds raised do not transit through France's national budget. Mr. Kazatchkine considered this project, together with other alternative initiatives, a necessary condition to fill in the huge financial gap for 2006.

Mr. Eric Goemaere of Médecins Sans Frontières (MSF) in South Africa provided a field perspective of long term challenges of anti-retroviral treatment (ARV) programmes against HIV/AIDS in Africa. The minimal objective of MSF is to offer an average of 10 years of survival treatment to AIDS victims. To attain these objectives, several issues have to be addressed. Firstly, Mr. Goemaere highlighted that the HIV/AIDS problem has no "quick fix", but is a long-term issue requiring long-term commitment from both the patients and care-givers. Although focus has been placed on prevention, this should not diminish the efforts to treat the millions of HIV/AIDS-diagnosed victims. Another concern is the financial cost of the HIV/AIDS treatment. For most of the HIV/AIDS infected people from developing countries, 40-60% of their income would have to be devoted exclusively to ARC treatments. As Mr. Bill Gates recently pointed out at the XIV International AIDS Conference in Toronto, "such a financial effort might not be sustainable if there is no improvement in the reduction of new infection rates", a sentence that could be interpreted as an early sign of donor's fatigue. There has been no major reduction in drug prices for the last two years despite enormous increases in drug consumption. Moreover, there is a need for cheaper and more user-friendly second line drugs, which are 5 times more expensive that first line drugs. The prerequisites for long term adherence to ARV treatment are free access to ARV, including user fees and collateral costs such as lab monitoring; peripheral rather than central approach; sufficient investment into human resources, in light of the recent high migration of nurses particularly to the UK and the USA; and counselling, community networking and peer support.

Some concern has been raised that "ARV programmes will pull away from the few resources available for primary health care service (PHCS) levels. Furthermore, the gap must be bridged between TB and HIV services, two obviously interlinked diseases. Mr. Goemaere stressed that broad health-care systems, patients, funding, and governments all have struggles that need fixing. He emphasized the current lack of strong political leaders, who have a key role as catalysts in changing public opinion and who should not be replaced by non-elected leaders.

Mr. Mario Raviglione, who represented the Stop TB initiative of the WHO based here in Geneva, focused his presentation exclusively on tuberculosis. He summarized the current burden of tuberculosis, a disease of poverty, whose control is a human right, a public good and a potential "quick-win" of the Millennium Development Goals (MDGs). Because TB is the biggest cause of death from a curable or preventable disease of today, Mr. Raviglione compared tuberculosis to "a SARS epidemic every day". Mr. Raviglione also stressed the link between TB and HIV/AIDS which are co-epidemics. TB is the first cause of HIV-related deaths in the world, causing more than 500,000 deaths per year. Moreover, the prevalence of multiple drug resistant (MDR) and extremely drug resistant (XDR) tuberculosis is on the rise. The economic impact of TB can be seen in both the macro- and micro-economic fields. Cost of diagnosis and treatment is a huge concern for those directly affected and the major funding is required for large-scale mobilization of health care (clinics, hospitals with adequate treatment). There is notably a loss in economic productivity due to the 1.7 million annual deaths caused by TB, with most of the victims being economically productive adults. The regions most affected by TB, and where effort must be focused in order to attain the MDGs, are Eastern Europe and particularly Africa. The 2005 World Health Assembly set the aim to detect at least 70% of infectious TB cases and to successfully treat at least 85% of the detected cases. Current worldwide figures are respectively 53% and 82%.

Mr. Raviglione presented the Stop TB initiative which aim at decreasing the global burden of tuberculosis by 2015 in line with the MDG and Stop TB Partnerships targets. The strategy includes the following main points: pursue and expand high quality DOTs; address TB/HIV-AIDS, MDR-TB and other challenges; contribute to health system strengthening; engage all care-providers; empower people with tuberculosis and communities; enable and promote research. He concluded, "TB control is a marathon, not a sprint!"

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