by Bianca Auping-Kamps –Senior Fund Portfolio Manager, the Global Fund
In remote parts of Papua New Guinea, focusing HIV prevention on those most at risk of the virus is not straightforward. I was confronted with this in Port Moresby recently as I discussed the condom use of sex workers with some of the Global Fund’s implementing partners.
What happens, for example, when someone is trading sex for transport? While they may not identify as a sex worker, they are nonetheless potentially exposed to HIV. Reaching people like this is an absolute necessity.
Challenges like this informed a new grant we formalised in Papua New Guinea today. While Papua New Guinea has made good progress in reducing its HIV epidemic, only a grassroots, community-led approach will make fresh inroads against the disease.
That’s why the new grant focusses on behaviour. It looks at how people at risk of HIV act in the real world, but also the attitudes of those who need to support them, such as medical and criminal justice workers. In Papua New Guinea, gender based violence and stigma against men who have sex with men and transgender people is still very real. So the solutions need to be grounded and realistic.
For example, peer leaders in the transgender community will be trained to distribute condoms among their friends and colleagues and point them towards medical services, when necessary. Since these peer leaders will work with specific clinics, trust will deepen. At the same time, health workers will be trained to be more sensitive and receptive to groups such as men who have sex with men. In a more trusting, open environment, people are more likely to discuss their behaviour and address risk.
Today’s grant agreement is a good encapsulation of the Global Fund Partnership. Partners such as the Australian and US Government have worked with people affected by HIV as well as Papua New Guinea churches, health officials and private sector partners such as Oil Search Health Foundation to create this program. No one has all the answers but by working together in partnership we can have a genuine impact.
Global Fund News Flash
Viral load testing is the best way to know if a child is HIV positive. It’s also a powerful tool to determine if HIV drugs are working. The problem is that until now, the tests were often prohibitively expensive and contract terms varied.
New agreements struck between the Global Fund and seven diagnostic manufacturers aim to change that. After a year of in-depth negotiation and intense study of the market, the Global Fund sourcing team believes it’s found a route to affordable and stable prices, better contracting, and hopefully, expanded testing.
The manufacturers have agreed to provide the test components at a stable and competitive all-inclusive price as low as US$15 per test, which includes the cost of testing equipment. Today, tests can cost as much as US$85.
A more competitive price is welcome, but Christopher Game, the Global Fund Procurement head, explained that it’s not the only benefit of the agreement.
“What we were really after was transparency and reliability,” Game said. “So yes, the price reduction is great, because it will free up money to do more testing. But just as importantly, we now have transparency around the various components of that price, such as transport and machine maintenance.”
The machines required for the tests don’t come cheap, selling for around US$150,000. By stabilizing the other elements required to test, Game and his team expect to see an expansion in the number of tests done.
The agreement should deliver net savings of at least US$30 million over three years to the Global Fund, and potentially much more. Seven manufacturers have been through a technical and commercial evaluation before being added to the panel of suppliers. The framework agreements last at least three years. Other public health funders and agencies will also be able to enter into agreements based on the benchmark prices and contracting negotiated.
GENEVA, 18 May 2015—On HIV Vaccine Awareness Day, UNAIDS is calling for a renewed global commitment to finding an effective HIV vaccine.
“A vaccine would be a major step towards ending the AIDS epidemic,” said UNAIDS Executive Director Michel Sidibé. “There have been encouraging recent scientific advances that give us hope for the future development of an HIV vaccine.”
UNAIDS is committed to leaving nobody behind in the HIV response. A major advantage of vaccines is that they promote equity and can be used effectively in all communities and settings, including those where many other health services can be harder to deliver.
Studies show that an HIV vaccine is possible. The RV144 vaccine trial in 2009 lowered the rate of HIV infection by 31%. There is much hope that ongoing research will build on this trial and deliver results. Newer vaccine candidates, as well as neutralizing antibodies, are also being studied.
Vaccines have eradicated smallpox, and polio is close to eradication. Vaccines have also effectively controlled diphtheria, pertussis, tetanus, mumps, measles and rubella, among other infectious diseases.
However, in 2013, HIV vaccine research and development saw the largest decline in investment since 2008. In order to transform promising concepts into an effective and accessible vaccine increased and sustained funding will be critical.
Port Moresby – Lady Roslyn Morauta, Chairperson of the Papua New Guinea Country Coordinating Mechanism (CCM) for the Global Fund, said today that she was delighted that the Global Fund had continued its support to health programs in Papua New Guinea by signing three new grant agreements worth US$50 million to the end of 2017 for Malaria, Tuberculosis and Health System Strengthening.
Since 2004, the Global Fund has approved grants for Papua New Guinea worth US$187 million. In addition to this, a total of US$83 million has been approved by the Global Fund for Papua New Guinea for 2014-2017.
At the grant signing ceremony held at the National Department of Health, Lady Morauta thanked Dr Mark Dybul, the Executive Director of the Global Fund, and representatives of donors to the Global Fund. The financial resources provided through the Global Fund come from many donors, represented in Port Moresby today by the Australian High Commissioner, and the Ambassadors of the United States and the European Union.
She also thanked the Minister for Health, Hon Michael Malabag and Health Secretary Pascoe Kase for working closely with the CCM to meet grant conditions and to finalise the grant proposals to the Global Fund.
The CCM is a multi-stakeholder body, including representatives from the Government, the private sector, churches, NGOs, academic institutions, multilateral and bilateral agencies, and people living with the diseases targeted by the Global Fund (HIV, TB and Malaria). The CCM develops and submits grant proposals to the Global Fund based on the priority needs of the disease strategies of the National Department of Health. After grant approval, the CCM oversees progress during the implementation, so it plays a key role in oversight of the grants. Drawdown of funds is based on performance.
The Implementers/Principal Recipients for the new grants are Rotarians Against Malaria and Population Services International for Malaria, and World Vision for TB. The TB grant also has an over-arching Health System Strengthening component.
“The key to success of these grants is not just the commitment and hard work of the Principal Recipients, but a close working relationship with the National and Provincial Health Departments and District Authorities, who in fact carry out a large bulk of the activities funded by the grants,” Lady Morauta said.
The CCM Chair noted that the Government’s investment in Global Fund supported programs was significant. For the period 2012-2014 the government contribution to the programs totaled US$62 million. This is expected to increase by 78% during 2015-2017, with an indicative budgeted amount of US$110 million.
“The CCM is proud that the PNG Government’s commitment to these programs is strong. This is an important achievement. The initial Global Fund programs in PNG were almost entirely funded by the Global Fund, which caused problems when the grants ended. The close of the first HIV grant, for example, left many gaps in government and church HIV services, and also for patients. The sustainability of these programs is critical. The Government now recognises the importance of continuity, and is making a substantial co-financing contribution.”
Lady Roslyn also paid tribute to the Australian Government, the World Health Organisation and UNAIDS for the on-going technical and financial support they provided to the CCM.
The grant agreements were signed by Dr. Mark Dybul, Executive Director of the Global Fund, Gabriele Ganci, Country Director of Population Services International, Ron Seddon, Chairman of Rotarians Against Malaria, Tim Costello, CEO of World Vision Australia, Curt Von Boguslawski, Country Director for World Vision, Roslyn Morauta as Chair of the PNG CCM and Heni Meke, representing civil society organisations on the CCM.
The two malaria grants, worth a combined total of US$32 million, will be used to fund purchase and distribution of 2.8 million mosquito nets and training of community health workers. The grants will also support prompt diagnosis of malaria, strengthen monitoring and improve access to care for the country’s most disadvantaged communities.
The other US$18 million grant, to be administered by the international and Australian divisions of World Vision, aims to reduce the incidence and prevalence of tuberculosis in PNG. The grant will be used to improve the recruitment and retention of clinical staff. It will also strengthen the systems needed to enable access to quality drugs and laboratory diagnostics for HIV, TB and Malaria, helping to build a stronger health system as a whole.
Lady Morauta said that, thanks to previous funding from the Global Fund and the strategy followed by the National Government, Papua New Guinea had made tremendous progress in its campaign against malaria. According to the World Health Organisation, malaria prevalence has decreased from 12.1 per cent to 1.8 per cent. Key to this success has been an aggressive mosquito net distribution program. Approximately 82 per cent of households now own at least one net.
More cases of tuberculosis are being treated than before and case detection of the disease has risen to 89 per cent in 2013 from 61 per cent in 2010.
“The new grants build on the success of the previous Global Fund grant programs. We look forward to further reduction in the incidence of malaria, and to an acceleration of the campaign against TB, which is now a very serious public health issue in Papua New Guinea,” Lady Morauta said.
Global Health News
Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.