Case Studies: Martina Morris
Sam Clark |
Jonathan Gorstein - Abstract |
Jonathan Gorstein - Outline |
Anne Marie Kimbal |
Ann Kurth
Martina Morris |
Beth Rivin |
Bettina Shell-Duncan |
Clarence Spigner |
Joe Zunt |
Combined
The 3 by 5 Initiative
On World AIDS Day 2003, WHO and
UNAIDS released a detailed and concrete plan to reach the 3 by 5 target of
providing antiretroviral treatment to three million people living with AIDS in
developing countries and those in transition by the end of 2005. This is a
vital step towards the ultimate goal of providing universal access to AIDS
treatment to all those who need it.
THE PROBLEM IS URGENT
- 30 million people have died in two decades. 40
million more people are infected.
- In poor countries, 6 million people with
HIV/AIDS need immediate ART. Less than 8% get it.
- Worst hit is sub-Saharan Africa. With 28.5
million people infected, HIV/AIDS has destroyed communities, health care
systems and put a shadow upon the future of entire countries.
WHY ANTIRETROVIRAL THERAPY (ART)?
- ART prolongs lives, making HIV/AIDS a chronic
disease, not a death sentence. Affluent countries have seen a 70% decline
in HIV/AIDS deaths.
- ART will help calm fears and change attitudes
towards HIV.
- ART, as part of a prevention plan, can
significantly reduce HIV transmission.
- ART, once very costly, is now much more
affordable.
- ART can reduce overall health care costs and
restore quality of life.
- WHO and UNAIDS are working to make ART
accessible to all.
WHAT WILL 3 by 5 DO?
To reach the 3 by 5 target, WHO and
UNAIDS will focus on five critical areas:
- Simplified, standardized tools to deliver
antiretroviral therapy.
- A new service to ensure an effective, reliable
supply of medicines and diagnostics.
- Rapid identification, dissemination and
application of new knowledge and successful strategies.
- Urgent, sustained support for countries.
- Global leadership, strong partnership and
advocacy.
- WHO, countries and other
partners need to train 100 000 health workers, develop health systems and
build infrastructure and standards.
US$ 5.5 billion over current commitments.
Potential Problems:
- Is HIV the
most important priority for global funding and activities?
- Will mass treatment
lead to rapid development of antiviral resistance?
- Will treatment lead
to behavioral disinhibition?
Epidemiology, Health Services,
Methods/Statistics/Modeling, Biology, Social Sciences
Learning objectives:
- How should priorities be
defined?
- What is the right metric?Death? DALY? Morbidity? QALY? Orphans?
- Does donor interest matter?
- Does capacity building matter?
- Should we focus on eradication
or reducing prevalence?
- How seriously should we take
the arguments that AIDS is not caused by HIV?
- Measuring the burden of disease
- Where do the data come from?
- Which agencies have
comprehensive data?
- Sentinel surveillance vs. pop
based surveys (representative samples)
- Response rate bias
- What does capacity building involve?
- Health service organizations
- Public infrastructure (roads, water, safety)
- Human resources (training models and brain drain)
- The difference between
individual and population level outcomes
- Metrics for patient improvement
- Metrics for population health
- Mechanisms that link individual and population outcomes
- Conflicting goals
Individual health and freedom vs. evolution of drug resistance
Individual health and freedom vs. compensating behavioral change
Reducing death rates vs. reducing incidence
' The highest attainable standard of
health is one of the fundamental rights of every human being, without
distinction of race, religion, political belief, economic or social
conditions’
~ Constitution of WHO |
What does it mean to say that “the
highest attainable standard of health” is a right regardless of economic and
social conditions?
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