When the Clinton Health Access Initiative (CHAI) was founded in 2002, only 200,000 people were receiving treatment for HIV/AIDS in low and middle income countries with medicines that cost over $10,000 per person per year. The issue of absorptive capacity was constantly raised as many questioned whether recipient countries could effectively utilize funds and afford to provide large scale treatment without encountering bottlenecks in their healthcare systems.
Over a decade later, more than eight million people are receiving treatment and CHAI has helped reduce the cost of medicines to around $100 to $200 per person per year in many countries. More than five million people have access to treatment at these CHAI-negotiated prices. Additionally, countries have repeatedly proven that it is possible to rapidly scale up treatment services. Currently, CHAI is working with South Africa – the country with the largest number of HIV positive people in the world – to triple the number of people receiving antiretroviral treatment within four year’s time.
While more resources are needed to fight HIV/AIDS, we can also do more with the money we have. CHAI believes that the fight against HIV/AIDS requires not only the funds of governments and donors, but also the brains of those who can identify better ways of economizing while still improving quality of care. Accordingly, CHAI is working to help governments and donor agencies get the most out of money that is invested in treating HIV/AIDS. CHAI approaches this in three main ways. First, by changing the economics of care and treatment. Second, by helping governments accelerate large scale up of critical treatment programs. And third, by helping to drive uptake of key products such as medicines and diagnostic tools.
Exciting new advances in the fight against HIV/AIDS are emerging. New findings show that putting HIV-positive people on treatment while they are healthy can also curb transmission to non-infected sexual partners by 96%. CHAI will be putting this “treatment as prevention” strategy into action for more than 90% of people in Swaziland, the country with the world’s highest HIV prevalence rate at 26%. Treatment is also the primary intervention to prevent maternal to child transmission (PMTCT) of HIV, with upward of 80% of infections being averted by having women who are eligible receive the treatment. Going forward, CHAI will assist a broader set of governments to effectively plan and manage the scale-up of their PMTCT programs. CHAI will also increase survival rates in many countries by helping governments initiate earlier treatment, making greater use of new microbicides as they come to market and are proven effective, and using new tools to increase testing for tuberculosis and other opportunistic diseases among people living with HIV. While all of these new interventions hold great promise, there is often a lag between scientific proof of efficacy and full uptake of new technologies and services. CHAI will continue focusing on key activities required at each step along a product’s or service’s path to market in order to drive widespread uptake.