HIV and Health Systems: Research to Bridge the Divide

Department of Health Policy and Management, Columbia University Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 08/2011; 57 Suppl 2:S120-3. DOI: 10.1097/QAI.0b013e31821e8de4
Source: PubMed


Concern that HIV programs in low-income countries may strain weak health systems and undermine achievement of other priority health goals has resulted in a research agenda focused on measuring the effects of past HIV investments on non-HIV services and outcomes. However, this research has limited value for informing future health policies and programs, which increasingly view health systems as the common platform for delivery of HIV and other health services. These policies reflect a shift in the framing of HIV care and treatment from emergency response to routine health service. In this paradigm, relevant areas for research are strengthening, scaling, and sustaining health systems in low-income countries to reduce all-cause mortality and morbidity, including deaths from HIV. To build an evidence base to support current and future health systems and policy, researchers need to move from retrospective studies to prospective research and adopt innovative study designs and analytic methods.

1 Follower
3 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Africa carries a disproportionate burden of the global HIV endemic, accounting for two thirds of the global 33.3 million people living with HIV. While tremendous advances have been made in addressing the HIV epidemic in Africa, considerable challenges remain. Testing for HIV increased by 86% from 2007 to 2009 but more than 75% of people 15-49 years remain unaware of their HIV status. CD4 count at diagnosis tends to be low and linkage to care and treatment is suboptimal. The scale-up of antiretroviral therapy is ongoing but is hampered by the lack of diagnostic capability to monitor response to therapy and a substantial healthcare workforce shortage. Prevention strategies such as male circumcision, pre-exposure prophylaxis, and antiretroviral therapy for prevention have generated great excitement but cost and healthcare infrastructure deficiencies may limit their widespread applicability. Operational research to validate and inform treatment decisions, health care policies, and prevention strategies is sorely needed.
    Current Infectious Disease Reports 12/2011; 14(1):91-101. DOI:10.1007/s11908-011-0230-8 · 1.68 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: International donors financing the delivery of antiretroviral treatment in developing countries have recently emphasised their commitment to rigorous evaluation of antiretroviral treatment impact on population health. At the same time frame, but for different reasons, they have announced that they will shift funding from vertically structured (ie, disease-specific) interventions to horizontally structured interventions (ie, staff, systems and infrastructure that can deliver care for many diseases). The authors analyse likely effects of the latter shift on the feasibility of impact evaluation. The authors examine the effect of the shift in intervention strategy on (1) outcome measurement, (2) cost measurement, (3) study-design options and the (4) technical and (5) political feasibility of programme evaluation. As intervention structure changes from vertical to horizontal, outcome and cost measurements are likely to become more difficult (because the number of relevant outcomes and costs increases and the sources holding data on these measures become more diverse); study-design options become more limited (because it is often impossible to identify a rigorously defined counterfactual in horizontal interventions); the technical feasibility of interventions is reduced (because lag times between intervention and impact increase in length and effect-mediating and -modifying factors increase in number) and political feasibility of evaluation is decreased (because national policymakers may be reluctant to support the evaluation). In the choice of intervention strategy, policymakers need to consider the effect of intervention strategy on impact evaluation. Methodological studies are needed to identify the best approaches to evaluate the population health impact of horizontal interventions.
    Sexually transmitted infections 03/2012; 88(2):e2. DOI:10.1136/sextrans-2011-050303 · 3.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Donor funding for HIV programs has increased rapidly over the past decade, raising questions about whether other health services in recipient-country health systems are being crowded out or strengthened. This article--an investigation of the impacts of increased HIV donor funding on non-HIV health services in sub-Saharan Africa during 2003-10--provides evidence of both effects. HIV aid in some countries has crowded out the delivery of childhood immunizations, especially in countries with the lowest density of health care providers. At the same time, HIV aid may have positively affected some maternal health services, such as prenatal blood testing. These mixed results suggest that donors should be more attentive to domestic resource constraints, such as limited numbers of health workers; should integrate more fully with existing health systems; and should address these constraints up front to limit possible negative effects on the delivery of other health services.
    Health Affairs 07/2012; 31(7):1406-14. DOI:10.1377/hlthaff.2012.0279 · 4.97 Impact Factor
Show more