How to Measure Effectiveness of HIV Response

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The Millennium Development Goals have provided specific and measurable goals that countries have worked towards, but it is difficult to ensure that these goals are being measured in the right way.

For instance, HIV testing centers often receive funding based on the annual number of tests they administer. This is a poor gauge of measurement because some individuals are more likely to test positive, even in countries in which the epidemic is widespread across the population.

This means that one center could be listed as highly performing even though it only reached a high number of annual tests by retesting member of the same low-risk population.

On the other hand, a center that only tests individuals who are likely to have become infected receives less funding because it tests fewer people. Yet, this center may also find more infected people because it tested those who were highly likely.

It is also important to accurately measure the effect of HIV testing and counseling on individuals, so as to determine the most efficient and effective health service.

Notifying patients of their status has little impact. Those who test positive should be directed to care, and those who test negative should be directed to prevention services.

Likewise, the focus on the number of HIV-positive individuals receiving treatment does not take into account the fact that antiretroviral treatment only prevents illness and death when patients are given the correct medicine and abide to their prescribed regimens. This can be difficult to ensure. Some treatment centers have more 1/3 of their patients dropout annually, and others fail to control HIV in many patients.

Sadly, this means that more than eight million people who reported to be on treatment at the 2012 International AIDS Conference, UNAIDS (the Joint UN Programme on HIV/AIDS) may have not received the proper treatment needed to survive.

What is the solution?

Treatment centers need to be evaluated based on the number of people who have stayed in care and regularly take their prescribed medication. An even better solution would be to track whether HIV replication is suppressed in each patient.

This is possible to do. Clinics can measure and report the number of their patients that stay alive, and pinpoint the reason why some patients stop coming in to receive care. Reductions in the cost of viral load tests will also help an increased number of clinics track patients’ health, and provide clinicians with important information on how to best treat each patient.

Measuring the correct attributes will increase the effectiveness of HIV response and enable performance to improve and thereby enable clinicians to save more lives.

– Kasey Beduhn

Source: Impatient Optimists

Photo: NPR

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