Identifying gaps and setting targets
Data is crucial for making the investment case for AHD. Many low- and middle-income countries have a lot of data — the problem is that it’s not centralized or easily accessible, making it difficult for managers and policymakers to use it as a basis for decision making and resource allocation, explained Muthoga. “We need to find a way to harmonize that data.”
The lack of data becomes especially problematic when donors withdraw funding for projects and the government is left to take over. Muthoga believes one of the reasons this often happens isn’t because they lack funds, but because there is no data to support the need for projects.
“We shouldn't look at screening programs for advanced HIV and opportunistic infections as a burden, but more as a solution to our problems. Because if they don't get the treatment they need [on time], it will end up costing their lives, first of all, and second of all, taxpayer money.”
Charles Muthoga
Health Economist and Research Associate
Botswana Harvard AIDS Partnership
As a health economist, he calculates the cost effectiveness of health interventions.
“A cryptococcal antigen test — a screening that is standard for a CD4 count of less than 100 — costs the government about $5. If we don't implement that screening program and the patient ends up getting cryptococcal meningitis, that patient will spend at least $2,500 for treatment, and that's on a 50/50 outcome,” he said.
Data is also needed to establish priorities and show donors where financing is needed.
“It comes down to having the data and demonstrating the gaps to donors and being able to convince them that this is where money needs to be spent … if not, you run the risk of donors imposing certain priorities over a country’s national HIV program without necessarily looking at the country’s priorities,” said Dr. David Meya, infectious disease physician and lecturer at the Department of Medicine at the College of Health Sciences at Makerere University in Uganda.