‘We need to expand four- or five-fold from where we are now to reach all those who need antiretroviral treatment. But it will take years to train enough doctors and nurses to manage this,’ said Dybul on Wednesday.
‘Once an AIDS treatment programme is up and running, it doesn’t need a high level of expertise,’ said Dybul, , who is in South Africa to attend the annual meeting of the implementers of the US President’s Emergency Plan for AIDS Relief (Pepfar).
Countries needed to look at harnessing other human resources so that they could scale-up. Nurses and ‘clinical officers’ could monitor patients instead of doctors, while lay people could do HIV counselling and testing instead of nurses, he added.
In Uganda, lay people had been trained as ‘clinical officers’ to monitor patients on anti-retroviral (ARV) therapy. However, in South Africa only a registered nurse can conduct an HIV test, while South Africa’s ARV treatment programme is hospital-driven.
Pepfar is a $15-billion, five-year initiative which was started by US President George W Bush in 2003 to fight AIDS. By the end of the year, it will have disbursed over $450-million in South Africa alone.
Since Pepfar started disbursing funds in January 2004, mainly to 15 focus countries almost of which are in Africa, it had supported over 561 000 on ARV treatment.
‘Communities that have been in total despair, believing that they are headed for death, have been transformed after six months of ARV treatment to have hope,’ said Dybul.
‘Nothing can match the look on a nurse’s face when she sees a patient who has been near to death coming back to life. Suddenly she understands: ‘we can do this. We can save lives’.’
Many Pepfar-funded treatment programmes were using brand-name ARVs rather than cheaper generic drugs because their host countries had not registered the generics, not that the US was blocking their use, said Dybul. Pepfar funds generic drugs approved by the US Food and Drug Authority.
Pepfar has been widely criticised, including by the US Congress’ Government Accountability Office for funding AIDS prevention programmes that promote abstinence and fidelity rather than condom use.
However, Dybul defended Pepfar’s bias, saying that in the past condom use had been over-emphasized.
‘There is consensus that the ABC approach ‘ abstinence, be faithful and use condoms ‘ is an effective prevention strategy. But there has been a tremendous imbalance in favour of condoms. It is completely untrue that we are only promoting abstinence and be faithful. We have doubled condom provision since 2001, but we are doing this in the context of abstinence and fidelity.’
Besides, said Dybul, while Pepfar was the largest single initiative in history established by one country to fight one disease, it was ‘not the only resource and should not be expected to cover everything’.
Dybul stressed that although Pepfar was a five-year programme due to end in 2008, it had the support of both Republicans and Democrats and ‘there is no question in anyone’s mind that the US will continue to support the fight against AIDS’.