Médecins Sans Frontières sent a letter to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to express concern over the financial resource scenarios for 2011-2013 it released at the first meeting for the Third Voluntary Replenishment on 24-25 March 2010 in The Hague. MSF raised concerns that the resource scenarios presented to donors were not based on December 2009 WHO clinical recommendations for management and prevention of HIV.
Executive Director
Global Fund to Fight AIDS, Tuberculosis and Malaria
Dear Professor Kazatchkine,
I am writing to you on behalf of Médecins Sans Frontières to express concern over the financial resource scenarios for 2011-2013 the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is releasing at the upcoming first meeting for the Third Voluntary Replenishment on 24-25 March 2010 in The Hague.
We are deeply concerned that the resource scenarios presented to donors are not based on the new WHO clinical recommendations for management and prevention of HIV, released in December 2009, that reflect a substantial evidence base on the benefits of implementation of these guidelines. In short, the Global Fund is taking a position that disregards the latest clinical evidence and sends a contradictory message to developing countries, several of which have already taken steps to make their AIDS programmes consistent with the new WHO guidelines.
MSF provides HIV/AIDS treatment to over 140,000 people in more than 30 countries and can attest to the importance of these changes. The benefits of the new recommendations include: earlier initiation of ARV therapy to improve survival, reduce the risk of tuberculosis and other opportunistic infections, and reduce community-level viraemia; the use of more robust antiretroviral drugs (ARVs) that cause fewer side-effects and can delay a switch to more costly second-line therapy; increased viral monitoring to reinforce adherence and avoid treatment failure; the provision of second-line and salvage ARV regimens. WHO also recommends improvements in PMTCT protocols to further reduce the risk of vertical transmission that also needs to be taken into serious consideration.
These are evidence-based measures to increase quality of patient care and public health goals. There is also evidence that these policy changes will ultimately result in cost savings by avoiding the need for more complex and resource-intense care at a later stage. It is therefore a matter of concern that the Global Fund’s message on financing needs fails to include these measures as a basis for estimating needs.
Financial forecasting should not be based on suboptimal treatment regimens and outdated treatment and prevention protocols, particularly as these practices are being phased out in a growing number of countries. As countries will request funding through reprogramming of existing grants as well as through new proposals, the Global Fund should anticipate these higher expenditures as part of the 2011-2013 Replenishment period. Without such support, countries may be forced to delay implementation of the new guidelines leading to the wilful continuation of less-than-optimal treatment and less effective prevention for implementing countries.
Similarly, GFATM financial resource scenarios do not take into account the latest evidence base for the management of malaria and tuberculosis. WHO's revised guidelines recommend confirmatory diagnostic testing of malaria for those on artemisinin-based combination therapy (ACT). For tuberculosis, WHO estimates that the response to M/XDR-TB will require a 16-fold funding increase between 2010 and 2015. GFATM financing scenarios are unclear about how these new recommendations will be supported financially.
The WHO has taken considerable effort to ensure that its recommendations take into account the latest evidence of what works best for patients in resource-limited settings. The Global Fund should support this effort fully by providing clear financing forecasts for these new recommendations. In light of the critical importance and feasibility of improved interventions in these three diseases, new scenarios must be generated.
We hope you will take our concerns into consideration during the Global Fund Replenishment meeting this week, and we are eager to speak with you in the near future and in greater depth about our concerns and perspectives.
Yours sincerely,
Tido von Schoen-Angerer, MD
Executive Director
Campaign for Access to Essential Medicines
Médecins Sans Frontières International