Shona Dalal

The presentations in this session focused on strategies for reaching the 90-90-90 UN targets, and the impact of PEPFAR funding on HIV outcomes and non-HIV related services.

Jess Wilhelm presented that discontinued PEPFAR funding did not impact HIV and other health outcomes in supported and non-supported facilities, although staff perceived disruptions in staffing and services. Sopheap Seng showed a specifically-hired case-management coordinator improved HIV case detection, ART initiation, and viral suppression. Mariya Makovetska demonstrated large gaps in the 90-90-90 cascade in Ukraine. Decentralizing HIV testing from specialized regional AIDS centers to primary health care centers increased testing uptake and new cases detected. Brook Nichols presented a geospatial model to estimate the incremental costs of reaching “last mile” 20% of patients in Zambia by expanding a sample transportation network. Coverage over 90% increased costs substantially due to the high number of kilometres driven for rural areas. Dale Aubrey Barnhart showed in a quasi-experimental analysis that annual PEPFAR PMTCT funding may be associated with reduced infant mortality and increased HIV testing at ANC, which increased over time, in Kenya.

Different context-specific approaches to reaching the 90-90-90 targets were were successful. Integrating services such as in Ukraine and considering the sustainability of approaches dependent on external support bears further deliberation. The marginal benefit of increasing services such as viral load coverage above a certain threshold is deabatable in resource-constrained environments when other options may suffice. Reductions in PEPFAR funding showed no statistical difference in HIV- and health-related outcomes. Although PEPFAR PMTCT funding may have had a cumulative annual effect on outcomes such as infant mortality, the contributions of country-led programs and donors such as Global Fund makes attribution difficult.