By David Garmaise,
The Global Fund Board recently approved $24.5 million in renewal funding for an HIV grant and $8.5 million for a TB grant in Eritrea, both administered by the Ministry of Health.
HIV Grant (ERT-H-MOH)
The goal for the next implementation period of the HIV grant is to provide services to at least 85% of people who need antiretroviral therapy (ART) by 2016: some 8,516 adults and 946 children, in line with the World Health Organization updated guidelines on the use of ART.
Targets include an increase in the proportion of adults and children known to be on treatment 12 months after initiation of ART to 92% (from 85% in 2012); lower HIV prevalence in sex workers to 4.5% (from 5.8% in 2011); and a lower proportion of infected infants born to HIV-positive mothers to 2% (from 5.8% in 2011).
For the next implementation period, additional funding has been allocated to TB/HIV collaborative activities and early infant male circumcision initiatives.
According to the GAC, Eritrea has a generalised epidemic with some characteristics of a concentrated HIV epidemic among key populations. Data from 2010 showed an HIV prevalence of 0.93% among adults between the age of 15 and 49, with women twice as likely to be HIV-positive than men. A 2012 survey revealed prevalence rates of 5% among sex workers and 2% among long-distance truck drivers.
Health care in Eritrea is provided free of charge or at a very nominal fee. The country is implementing its fourth National Strategic Plan for HIV until 2016, which aims to achieve universal access, no new HIV infections, no discrimination and no AIDS-related deaths. The Global Fund is the only significant external source of funding for HIV activities in the [country].
When it reviewed the request, the GAC raised concerns about the absence of data on key populations (notably injected drug users and men who have sex with men); the perceived lack of civil society engagement; and the human rights situation in the country.
The GAC recommended that some Phase 2 funds be used to provide an analysis of gender and human rights issues. The GAC also highlighted the need to invest in effective HIV programmes in prisons. These issues will be dealt with during grant-making and in Phase 2 implementation.
GFO understands that the MoH plans to undertake a modes-of-transmission study by end 2013, in collaboration with UNAIDS. The MoH will undertake other studies in the next implementation period, with the support of UNAIDS and WHO, the results of which will be used to target key populations.
The GAC said that because of the importance of TB/HIV collaborative activities, an indicator on TB/HIV should be included in both the HIV and the TB grants.
TB Grant (ERT-T-MOH)
The next implementation period of the TB grant will see expansion of both scope and scale, including the introduction of GeneXpert technology and infrastructure support for a new TB laboratory; the targeting of miners and diabetics; and the integration of TB advocacy, communication and social mobilisation into other programmes.
Estimated TB incidence in Eritrea in 2012 was 97 per 100,000 population with prevalence at 151 per 100,000, and mortality (excluding HIV) at 4.7 per 100,000. The estimated prevalence of multiple-drug-resistant TB (MDR-TB) in 2011 was 1.8% among new cases and 19% among re-treatment cases. According to the 2010–2014 National Strategic Plan for TB, TB services are free of charge and cover the entire population.
The GAC said more effort was needed to map and then access key affected populations, including people living with HIV, prisoners, miners and refugees. The Global Fund is the only significant external source of funding for TB activities in Eritrea.
Concerns were raised about “insufficient human resources negatively affecting programme implementation and performance”: an endemic problem in Eritrea with no obvious solutions.
The GAC approved an investment of up to $1 million, over and above what was requested in the budget, to fund alternative power sources needed to stabilise the electricity required to run GeneXpert machines. These alternate power sources may also have broader health system benefits, including in warehouses, and hospital pharmacies and refrigerators.
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