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Targeting Criteria in National ARV Programs: Mexico, Senegal, and Uganda. XV International AIDS Conference Bangkok, July 2004. Catherine Chanfreau, MD, MPH Sara Bennett, PhD Abt Associates, Bethesda, USA . Presentation objectives .

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targeting criteria in national arv programs mexico senegal and uganda

Targeting Criteria in National ARV Programs: Mexico, Senegal, and Uganda

XV International AIDS Conference

Bangkok, July 2004

Catherine Chanfreau, MD, MPH

Sara Bennett, PhD

Abt Associates, Bethesda, USA

presentation objectives
Presentation objectives
  • Identify explicit factors used to target government-subsidized ART in Uganda, Senegal, and Mexico
  • Review priority criteria used in two national ART programs and one major pilot project
background
Background
  • Continued gap between access to and need for ART
  • Explicit policy commitment to provide ART to all those in need
  • Not always feasible in the short term: interim targeting is occurring
  • International clinical guidelines on how to scale up ART exists
  • Lack of policy guidance on how best to allocate scarce life-saving resources
selection process in the proposed ugandan national arv policy
Selection process in the proposed Ugandan National ARV Policy

HIV+ Individual

Meets clinical eligibility criteria

Assessment of likely adherence

Unlikely to

comply: excluded

Likely to comply:

Eligible HIV+ individual

  • Priority eligibility for:
  • Pregnant women (PMTCT)
  • Health workers (PEP)
  • Mothers identified in PMTCT and their HIV infected family members (PMTCT+)
  • Orphans and vulnerable children
  • People enrolled in support activities
  • Participants in research projects

Ordinary eligibility

ACCESS TO

FREE ART

IMMEDIATE ACCESS TO

FREE ART

selection process in the initiative s n galaise d acc s aux arv isaarv
Selection process in the Initiative Sénégalaise d’Accès aux ARV (ISAARV)

HIV+ Individual

Senegalese Residency

Meets clinical eligibility criteria

Social investigation: adherence & ability to pay

Likely to adhere:

Exempted from payment:

HIV/AIDS activists

Health workers

Unlikely to

adhere: excluded

Likely to adhere:

Eligible HIV+ individual

Determination of

patient’s

contribution

Patient accepts

contribution rate

ACCESS TO ART

selection process in national arv policy in mexico
Selection process in National ARV policy in Mexico

HIV+ Individual

Meets clinical eligibility criteria

Uninsured Individual

Insured Individual

  • Meets MoH program for free care (SSA*) eligibility criteria
  • Citizenship
  • Residency
  • Inability to pay for ART
  • Commitment to adhere to treatment

Consent to start and

Adhere to treatment

No prior history of

ART treatment:

Placed on waiting list

Previously

Treated on

ART

Priority accorded to

those at more acute stage

of disease

ACCESS TO ART

SSA: Programa de accesso gratuito a tratamiento Antiretroviral para la poblacion no asegurada de bajos recursos economicos

an anatomy of prioritization
An Anatomy of prioritization
  • Biomedical factors: patient’s clinical ability to benefit from ART
  • Prospects for adherence to treatment: patient’s likelihood to comply
  • Prevention-driven factors: “focused ART ” is the matching piece of UNAIDS “focused prevention” strategy
an anatomy of prioritization cont
An Anatomy of prioritization (cont.)
  • Social and economic benefits: positive externalities associated with sub-groups
  • Social and political empowerment: selection based on gender or role that individuals have played in the fight against HIV/AIDS
  • Financial factors: ability/inability to pay for treatment
  • Ethical arguments: poor and vulnerable children
conclusions
Conclusions
  • Targeting enables the scale-up of universal access to ART using a “step by step” approach
  • Explicit targeting criteria are used to allocate public subsidies andformulate policy strategies
  • Biomedical criteria are evidence-based
  • Prospects for adherence to treatment and biomedical criteria are used in virtually all settings
  • Social and political empowerment is a recurrent factor
  • Prevention-driven factors are internationally endorsed ( PMTCT plus)
thanks merci
Thanks … Merci
  • Governments of Uganda and Mexico
  • ISAARV team
  • USAID Uganda
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