Is too much money harmful for innovation?

Abstract

Significant sumshave been allocated to countries to enable them to make measurements of HIV viral load available at the level of districts and departments. Wanting to make this examination available to all HIV-infected patients appears fair, but it is possible to envision other strategies for decentralizing this process. It is generally agreed that every additional examination entails loss to follow-up and thus to treatment. On the other hand, a lack of resources induces more innovation, as demonstrated over the last half century for short courses of tuberculosis treatment, combined vaccines, and essential and generic drugs. Body weight is the best indicator for monitoring HIV viral load. We sought to determine if it is possible to raise awareness of this measurement that requires simple resources and provides an immediate result, available to healthcare providers in outlying areas. Specifically, we studied the measurement of body fat percentage, which appears to be a promising choice. A trial conducted in Casamance with an impedance meter incorporated into a commercially available scale yielded negative results for this specific task (measurement irregularities due to the condition of the soles of the patients' feet). It seems important to us to study scientifically the interest of this indicator scientifically and its performance in the field pragmatically, with more accessible measurement methods, such as skinfold (a method that has been demonstrated its efficacy in physical anthropology and in the domain of sports).