Edward Vallejo, ASPH/CDC Global Strategic Information Fellow

Does having access to clean water, stable electricity, and freedom from the fear of contracting an infectious disease make your list of major health and safety concerns? If you live in the developed world, the answer is most likely no, but for the last four months, I have been working in the West African country of Nigeria, where those issues and an ever-changing security situation are a regular part of my daily life. As a member of CDC Nigeria’s Strategic Information Team, my focus has been on HIV/AIDS, the global pandemic that is a leading cause of death for the 170 million people living in Africa’s most populous country.

Less than a month after arriving, I helped to coordinate a large-scale HIV/AIDS service and data quality assessment that involved 40 public health physicians, epidemiologists, strategic information and database specialists traveling to 18 medical facilities across the country. These personnel from CDC Nigeria, CDC Atlanta, the University of California at San Francisco, Nigeria’s Federal Ministry of Health and the Nigerian Field Epidemiology and Laboratory Training Program developed a detailed picture of the current state of services and data in those facilities. As a result, established and future programs will benefit from our recommendations, especially in preventing mother to child transmission of HIV/AIDS, an area in which Nigeria carries a substantial burden.

Debbi Birx, MD

As we usher in the New Year, I am struck by the incredible gains made – especially in the last 12-24 months – in the fight against HIV/AIDS and the key role the United States has played. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), under the leadership of the Office of the Global AIDS Coordinator (OGAC), has helped pave the way to historic progress. The U.S. Global AIDS Coordinator, Ambassador Eric Goosby, has strategically guided the implementation of PEPFAR by leveraging scientific advances, innovation, and the strengths of each PEPFAR implementing agency to ensure the greatest health impact. 

Photo: David Snyder/CDC Foundation

Unprecedented results

This impact was confirmed in the UNAIDS 2012 global report. New HIV infection rates have fallen by 50% or more in 25 countries with an additional 14 countries having achieved incidence declines ranging from 25% to 49%. Half of all reductions in new HIV infections are among children, reflecting strong progress towards the elimination of mother-to-child transmission. 

These unprecedented results also show increasing momentum over recent years as evidence-based, high-impact prevention interventions have been scaled-up. Importantly, the report also demonstrated that in a very small number of countries, stalling the expansion of HIV services can reverse hard won gains. 

This week, as scientists and public health partners meet at the International AIDS Society (AIDS 2012) meeting in Washington, D.C., one of the key challenges for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is to continue to increase the numbers of individuals on antiretroviral therapy (ART) while making sure that those who are currently on ART get quality care.

Increasing access to improved clinical management in resource-limited settings and identifying persons on ART whose treatment is beginning to fail is a key area where CDC, one of the key U.S. agencies implementing PEPFAR, brings its public health research and evaluation expertise to the table. Through research supported by PEPFAR, CDC in partnership with the Kenya Medical Research Institute (KEMRI) and the Kenya Ministry of Health and Sanitation will present at AIDS 2012 the results of three studies on viral load (VL) testing and illustrate how treatment access and outcomes can be improved.

By any measure, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) – in which CDC plays a key role – has proven to be a great success. Since its launch in 2003, PEPFAR has provided life-saving antiretroviral drug treatment for nearly 4 million people worldwide and last year alone provided care and support for nearly 13 million people and helped more than 200,000 infants to be born HIV-free. Still, millions more people are infected with the HIV virus ever year,  many of them children.

The bottom line? We need to work harder and smarter to take advantage of the new science for preventing HIV infections – all the more essential in the context of current global financial challenges. I am in Washington, DC this week at the International AIDS Society Conference to discuss how public health economics can contribute to achieving the goal of an AIDS-free generation.