Focus On Health Systems Strengthening, Not Disease-Specific Initiatives, Will Help Control HIV, Other Fatal Diseases

The Lancet: PEPFAR: is 90-90-90 magical thinking?
Scott Barnhart, professor of global health at the University of Washington

“The President’s Emergency Plan for AIDS Relief (PEPFAR) 3.0 has embarked on an important refocusing to achieve epidemic control through 90-90-90 (90 percent of HIV-positive individuals knowing their status, 90 percent of those receiving antiretroviral therapy, and 90 percent of those achieving viral suppression). Despite good intentions, the implementation is creating health system disruption. … The proposed investment in 90-90-90 underscores the inherent flaw of disease-specific initiatives — they ignore the needs of other worldwide fatal diseases. … For HIV to be controlled without a shift to a more cost-effective health-system strengthening model is magical thinking. … The world is too complicated for disease-specific approaches to health, as the ravages of Ebola in weak health systems have shown. A health-system strengthening approach will ensure that, especially in times of austerity, there are local institutions and infrastructure in place to provide care for all” (3/5).