Abstract
Improvements in geospatial health data and tailored human immunodeficiency virus (HIV) testing, prevention and treatment have led to greater microtargeting of the HIV response, based on location, risk, clinical status and disease burden. These approaches show promise for achieving control of the HIV epidemic. At the same time, United Nations Member States have committed to achieving broader health and development goals by 2030, including universal health coverage (UHC). HIV epidemic control will facilitate UHC by averting the need to commit ever-increasing resources to HIV services. Yet an overly targeted HIV response could also distort health systems, impede integration and potentially threaten broader health goals. We discuss current approaches to achieving both UHC and HIV epidemic control, noting potential areas of friction between disease-specific microtargeting and integrated health systems, and highlighting opportunities for convergence that could enhance both initiatives. Examples of these programmatic elements that could be better aligned include: improved information systems with unique identifiers to track and monitor individuals across health services and the life course; strengthened subnational data use; more accountable supply chains that supply a broad range of services; and strengthened community-based services and workforces. We argue that the response both to HIV and to broader health threats should use these areas of convergence to increase health systems efficiency and mitigate the harm of any potential decrease in health funding. Further investments in implementation and monitoring of these programme elements will be needed to make progress towards both UHC and HIV epidemic control.
Highlights
As the global human immunodeficiency virus (HIV) response matures, national programmes in low- and middle-income countries are providing lifesaving treatment for more than 20 million people and reaching millions more each year with prevention interventions.[1]. This progress has been achieved with support from donors such as the United States President’s Emergency Plan for acquired immune deficiency syndrome (AIDS) Relief and the Global Fund for AIDS, TB and Malaria. These investments have led to huge gains, with HIV-related mortality reduced by half compared with 2005 levels and a declining incidence of new infections in many countries and regions.[1]
HIV treatment models are being differentiated based on patient characteristics and context to optimize quality and efficiency, while the allocation of HIV-specific funding and the intensity of HIV services have become more deliberately targeted.[4]
Improvements in geospatial data and HIV testing, prevention and treatment services have led to microtargeting within the HIV response, based on location, population risk and illness severity
Summary
As the global human immunodeficiency virus (HIV) response matures, national programmes in low- and middle-income countries are providing lifesaving treatment for more than 20 million people and reaching millions more each year with prevention interventions.[1]. While HIV programme managers may not see the connection between their work and a primary health-care indicator like vaccination coverage, they may see the benefit of leveraging one another’s programming to strengthen the overall supply chain Global actors such as the World Bank and national governments are using the Vital Statistics Performance Index to monitor national progress in developing the civil registration and vital statistics systems that are fundamental to both diseasespecific and broader UHC goals.[41,42] Such systems monitoring should, in theory, sharpen the tracking and accountability for the effectiveness of investments in these areas, and encourage further investment and policy change. A series of commonly accepted indices could provide a greater incentive for greater cross-donor and disease co-investment in these basic elements of sustainable health responses, even if resources decrease
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
