Obama Administration outlines new direction for global AIDS prevention program

From the article:

"In an outline of a new direction for the global program launched by President George W. Bush, the Obama administration hopes to start handing off day-to-day management of AIDS prevention and treatment programs to the 15 countries where $19 billion has been spent since 2004. The goal is to make the services a routine part of each nation's health offerings.

The program provides AIDS drugs, HIV counseling and testing, prevention advice and condoms, palliative care for people with advanced AIDS and support for orphaned children. The services have been delivered through a complicated tiered system that includes American universities, international nonprofit organizations, government health ministries and hundreds of local charities.

Under a strategy described in documents released Monday, the countries' health ministries would assume the task of delivering services -- which many do already -- and would manage all the programs and measure their effect.

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The transition will require teaching supply-chain management, logistics, service coordination, program evaluation and other skills while continuing to provide AIDS services to millions of people. Some of the Pepfar partners have already begun.

The Elizabeth Glaser Pediatric AIDS Foundation, which has 12 offices in Africa, is a major provider of AIDS testing for pregnant women and treatment to prevent them from passing the AIDS virus to their babies. Most people doing the work are Africans, said Nick Hellmann, the group's executive vice president.

In three countries -- Mozambique, Tanzania and Zambia -- the foundation plans to spin off a local nonprofit by 2012 "so the money can come directly to them, and they can deal with everything from soup to nuts," Hellmann said.

The new direction comes at a time when the World Health Organization has revised its AIDS treatment guidelines in a way that will bring millions more people, especially women, into lengthy, often lifelong antiretroviral therapy.

WHO now recommends that people start antiretroviral therapy -- three medicines taken daily -- when key immune system cells called CD4 lymphocytes fall below 350 per microliter of blood. Previous guidelines, established in 2006, advised treatment only when the count fell below 200, a more advanced stage of disease. Normal CD4 count is 500 to 1,500 cells per microliter.

The new guidelines, which were announced last month, also call for pregnant, HIV-positive women to start taking antiretroviral drugs at the start of the second trimester, not just in the third. Both mothers and infants should take them for six weeks after delivery, and one or the other should continue on the medicines until breast-feeding stops."