From The World Bank Website 

Funding Seen as Biggest Challenge in Africa AIDS Treatment

November 28, 2006—When the World Bank and its partners teamed up for a pilot program to help learn about what it would take to scale up comprehensive HIV/AIDS services—including  providing new antiretroviral therapy to AIDS patients—in three African countries, they thought their biggest challenge might be making sure patients successfully followed their complex drug regimens.

But in practice, “the technical issues have not proven to be as big as we thought they would be,” says Albertus Voetberg, leader of the World Bank team involved in the 2-year-old Treatment Acceleration Project (TAP) in Mozambique, Burkina Faso and Ghana.

More worrisome are the uncertainties, says Voetberg—such as how to fund AIDS treatment that could continue for more than 20 years per patient in cash-strapped African nations, or how much AIDS drugs will cost in five years time.

“Once you start somebody on treatment, you have a moral or ethical obligation to continue. You cannot say well, sorry, the funds are finished, you die tomorrow. It’s just impossible,” says Voetberg.

Voetberg is a participant in a high-level AIDS conference, Sustaining Treatment Costs – Who will Pay? hosted by the World Bank, World Health Organization (WHO), and UNAIDS this week that looks at the issue of how more people who need antiretroviral treatment can get access to it, and how such treatment should be funded.

Some 4.6 million Africans have HIV infection serious enough to need life-prolonging ARV drugs—but only about a million people are getting them, according to UNAIDS.

The Bank, WHO and the United Nations Economic Commission for Africa (UNECA) launched TAP in 2004 to look for the best ways to provide and monitor AIDS treatment, with an eye toward scaling up the capacity of health systems to deal with the problem and incorporating lessons learned into existing and future AIDS programs, says Voetberg.

TAP is funded by a grant of US$59.8 million from the International Development Association (IDA), the part of the World Bank that helps the earth’s poorest countries reduce poverty by providing interest-free loans and grants for programs aimed at boosting economic growth and improving living conditions.

So far, over 90 percent of about 15,000 patients in the three countries have been able to adhere to their drug regimens with the help of highly motivated support groups, says Cassandra de Souza, TAP’s point person at the Bank’s headquarters in Washington, DC.

And while de Souza cautions it may be too early in TAP’s research to get a full picture of drug resistance among AIDS patients, so far there has not been as much need as expected for the more expensive second-line drug treatment.

In Mozambique, for instance, the failure rate of first-line ARV treatment is 3.5 percent a year, “which is quite low,” says Dr. Leonardo Palombi of Drug Resources Enhancement against AIDS and Malnutrition (DREAM), a non-governmental organization participating in TAP that was created by the Christian organization Community of Sant ‘Egidio.

DREAM, which began offering free Highly Active Anti-Retroviral Therapy (HAART) to Mozambique patients in 2002, is one of three NGOs participating in   Mozambique’s TAP program.

 The group delivers ARV to 20,000 patients. It has trained 1,000 health professionals and built specialized molecular biology laboratories for tests that aid in monitoring AIDS patients.

Palombi expects TAP data to he