Public service shrinkage reverses HIV/AIDS gains
Baboki Kayawe | Wednesday November 9, 2016 16:07
The research titled ‘2016 Botswana Investment: Investment Towards Effective HIV Prevention, Health System Strengthening and The End of AIDS’, further states that operations of clinical and administrative oversight are not keeping pace, and monitoring and evaluation systems have become unreliable and continue to weaken consequently.
Written by Ava Avalos, Heston Phillips and Keith Jefferis, the research reiterates startling findings of the 2011 Antenatal Sentinel Surveillance Survey that 50.2% of pregnancies were unplanned.
The researchers also emphasise the need for continuous HIV prevention strategies targeted at pregnant women, 10.2% of whom were HIV positive during their pregnancies at the time.
“This survey also highlighted the plight of poor, uneducated and unemployed women in the epidemic with HIV prevalence greater than 35% in day labourers, domestic helpers and those women who never attended school,” the authors wrote.
The research also notes that increasing health system fragmentation, exacerbated by weakly coordinated collaborations, strategic focus to successfully end AIDS remain a challenge to the war against HIV/AIDS.
“Many hospitals are challenged to maintain skilled human resources. Stock-outs of essential drugs, commodities and laboratory reagents have also become routine,” it read.
Yet another setback according to the study is that approximately 20% of the population still not having ever tested for HIV and declining testing annually, late presentation of HIV infected patients suffering from opportunistic infections continue unabated, almost at the same levels as at the start of the HIV response in 2001.
The impact of HIV positive patients waiting to test until they become sick and present for treatment, has created a tremendous burden on the healthcare system both in terms of costs and human resource requirements, stated the study.
“One result of the absence of any linkage to care is that known HIV positive individuals continue to present late at healthcare facilities only after they have become ill, with low CD4 counts and opportunistic infections. There is currently no way to estimate the average time it takes for a person receiving a positive HIV test result to present for HIV care.”
Moreover, there is no linkage to care system in place for those who test for HIV, neither for newly diagnosed HIV patients into treatment and care, or for non-infected patients into prevention programmes such as Safe Male Circumcision and Sexual Reproductive Health services.
Approximately 404,000 people were living with HIV/AIDS in Botswana at the end of 2015. Research further indicates about 330,000, 82% are aware of their HIV status.
During the 2014-2015 financial year, the MoH carried out an estimated 403,000 tests with 6.6 percent tests positive.
“Testing rates for males, couples, and young people remained low. Despite the multiple HIV testing options available, annual HIV testing in the general population also remains low and saw little improvement over the years as indicated by the 2008 and 2013 BAIS results, with similar levels of 15-49 year-olds testing for HIV during the previous 12 months at 61.7% and 63.7% respectively,” further said the study.
According to modelling estimates, under the current scenario, the total costs of HIV response are projected to rise from $187 million (P2.1 million) in 2016 to $244 million in 2030 (P2.7 million). With the newly introduced Treat All Strategy and enhanced treatment eligibility at CD4 500, a different cost pattern will be followed.
The Strategy promotes Universal Health Coverage and ensures that all who test positive get treatment no matter their viral load.
“Both are more expensive than the Baseline scenario in the early years, due to the higher numbers of people placed on treatment. However, in the Enhanced (CD4 500) scenario, costs keep rising reaching 17% above baseline by 2030.”
“In the Treat All scenario, costs are higher initially due to the rapid roll out, but eventually decline to 12% less than baseline by 2030, due to the impact on incidence.”
The study confidently stated implementing a comprehensive Treat All Strategy, Botswana would realise the greatest cost savings, gain epidemiologic control of HIV, improve treatment outcomes, protect the labour force and ensure the financial sustainability of the National HIV Response long term.
It further recommends among others maximised programming efficiencies inorder to sustain the HIV response in the long term.
“Efficiencies in decreased laboratory testing, serial HIV testing, task shifting and service delivery integration presents the largest opportunity for cost savings and have been included in the Spectrum Model estimates. With the implementation of new clinical care guidelines in 2016, additional efficiencies within the health care system are expected.”
The integration of HIV into routine service delivery will allow for synergies and crosscutting improvements for maximal efficiencies and cost savings.