Public Health Approach = Do the Best for the Most People Using Resources Efficiently

WHO promoted what we call "the public health approach," where we are doing the best for the most people possible using the resources in the most efficient way.

-- Meg Doherty, M.D., M.P.H., Ph.D.

While almost 60% of people living with HIV globally are on treatment, the numbers for new seroconversions averted and HIV-related deaths are no longer improving, Meg Doherty, M.D., M.P.H., Ph.D., with the World Health Organization (WHO) said in an interview with IFARA at AIDS 2018. This means the HIV community must make greater efforts to get people into treatment and engage them in care over a lifetime in order to maintain suppressed viral loads. The effort includes building bridges to key populations affected by the epidemic, such as young people who may lack information about sexual health, including HIV prevention.

One effort includes increasing access to newer, more tolerable medications. One promising new drug is dolutegravir (Tivicay, DTG), which is more potent and has a lower resistance profile than older medications. However, there is concern about its potential harm to the fetus in pregnant women, so WHO instituted a one-year surveillance program to determine the actual risk posed by the medication.

A low-priced combination pill containing the drug is available in low- and middle-income countries; however, the greater cost of the same pill in higher-income countries may keep it out of reach of low-income people in these countries, Doherty noted.

The organization's public health approach means that not every medication may be available to everyone in every country, but health care still needs to be people-centered. A provider needs to prescribe the best medication for a particular patient but can do so within the context of supply-chain efficiencies that limit the number of different drugs available in a specific country, she explained.

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