E-DRUG:MSF letter to Global Fund on the funding needed to improve HIV care
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Executive Director
Global Fund to Fight AIDS, Tuberculosis and Malaria
Chemin de Blandonnet 8
1214 Vernier
Geneva, Switzerland
Geneva, 23 March 2010
Dear Professor Kazatchkine,
I am writing to you on behalf of Medecins Sans Frontieres to express
concern over the financial resource scenarios for 2011-2013 the Global Fund
to Fight AIDS, Tuberculosis and Malaria (GFATM) is releasing at the
upcoming first meeting for the Third Voluntary Replenishment on 24-25 March
2010 in The Hague.
We are deeply concerned that the resource scenarios presented to donors are
not based on the new WHO clinical recommendations for management and
prevention of HIV, released in December 2009, that reflect a substantial
evidence base on the benefits of implementation of these guidelines.1 In
short, the Global Fund is taking a position that disregards the latest
clinical evidence and sends a contradictory message to developing
countries, several of which have already taken steps to make their AIDS
programmes consistent with the new WHO guidelines. MSF provides HIV/AIDS
treatment to over 140,000 people in more than 30 countries and can attest
to the importance of these changes. The benefits of the new recommendations
include: earlier initiation of ARV therapy to improve survival, reduce the
risk of tuberculosis and other opportunistic infections, and reduce
community-level viraemia; the use of more robust antiretroviral drugs
(ARVs) that cause fewer side-effects and can delay a switch to more costly
second-line therapy; increased viral monitoring to reinforce adherence and
avoid treatment failure; the provision of second-line and salvage ARV
regimens. WHO also recommends improvements in PMTCT protocols to further
reduce the risk of vertical transmission that also needs to be taken into
serious consideration.
These are evidence-based measures to increase quality of patient care and
public health goals. There is also evidence that these policy changes will
ultimately result in cost savings by avoiding the need for more complex and
resource-intense care at a later stage. It is therefore a matter of concern
that the Global Fund’s message on financing needs fails to include these
measures as a basis for estimating needs.
Financial forecasting should not be based on suboptimal treatment regimens
and outdated treatment and prevention protocols, particularly as these
practices are being phased out in a growing number of countries. As
countries will request funding through reprogramming of existing grants as
well as through new proposals, the Global Fund should anticipate these
higher expenditures as part of the 2011-2013 Replenishment period. Without
such support, countries may be forced to delay implementation of the new
guidelines leading to the willful continuation of less-than-optimal
treatment and less effective prevention for implementing countries.
Similarly, GFATM financial resource scenarios do not take into account the
latest evidence base for the management of malaria and tuberculosis. WHO's
revised guidelines recommend confirmatory diagnostic testing of malaria for
those on artemisinin-based combination therapy (ACT). For tuberculosis, WHO
estimates that the response to M/XDR-TB will require a 16-fold funding
increase between 2010 and 2015. GFATM financing scenarios are unclear about
how these new recommendations will be supported financially.
The WHO has taken considerable effort to ensure that its recommendations
take into account the latest evidence of what works best for patients in
resource-limited settings. The Global Fund should support this effort fully
by providing clear financing forecasts for these new recommendations. In
light of the critical importance and feasibility of improved interventions
in these three diseases, new scenarios must be generated.
We hope you will take our concerns into consideration during the Global
Fund Replenishment meeting this week, and we are eager to speak with you in
the near future and in greater depth about our concerns and perspectives.
Yours sincerely,
Tido von Schoen-Angerer, MD
Executive Director
Campaign for Access to Essential Medicines
Medecins Sans Frontieres International
CC :
Mr Richard Manning,Vice-Chair of the GFATM Replenishment
Global Fund Board Members
1 http://www.who.int/hiv/topics/treatment/evidence/en/index.html
Kind regards,
Michelle Vilk
Coordination and Communications Assistant
Medecins Sans Frontieres
Campaign for Access to Essential Medicines
Rue de Lausanne 78
1211 Geneva, Switzerland
Tel: + 41(0) 22 849 89 02
Fax: + 41 (0) 22 849 84 04
michelle.vilk@geneva.msf.org