Crunch time for funding of universal access to antiretroviral treatment for people with HIV infection

Much of the funding mobilised for the global response to HIV has supported successful expansion in antiretroviral therapy (ART) access, but funding is now at a critical juncture as the global financial crisis bites and funders hesitate. This paper considers the implications of faltering finances for universal ART access and argues for additional funding, used efficiently. The paper focuses mainly on sub-Saharan Africa as the region most badly affected by HIV and with the least resources to respond.

Progress in ART provision requires investment in strengthened health systems as well as in the health system elements most directly involved in ART provision. The paper finds that:

• the funds invested in achieving the current level of ART access are a platform for further progress
• faltering political and financial commitment threatens to stall progress towards universal ART access.

Although achieving efficiencies in healthcare delivery doesn't replace financing by donors and domestic funding, the authors provide proposals for maximising cost-efficiencies:

• disease-specific health initiatives and funding programmes should agree on a cross-cutting agenda for global health to maximise cost-efficiencies
• at country level, greater integration of HIV and other programme activities could improve efficiency and strengthen health systems
• scaling-up home-based ART and clinically driven rather than routine laboratory monitoring of ART side-effects can improve ART programme efficiency
• “how to do more with less” is a research priority for extending ART access in low-resource settings
• changes in wealthy nations’ trade policies are urgently needed to avoid creating new barriers for generic drugs.

Yet, the document still argues that donor countries’ support for policies to contain antiretroviral drug costs should complement their commitment to fund ART provision.