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On Targets and Timelines

TAGline Spring 2015

By Tim Horn

With growing recognition that science and discovery have forged the tools necessary to effectively diagnose, treat, and, indeed, eliminate three of the world’s most lethal infectious diseases—HIV/AIDS, tuberculosis, and hepatitis C—there is a need for greater mobilization and strengthened accountability among all stakeholders. Universal frameworks in which this can be achieved require time-bound targets: collaboratively developed, metrics-driven goals to optimize health outcomes among those living with the disease(s) and to minimize incidence among vulnerable individuals.

In this issue of TAGline, we focus on several target-based strategies—or the lack thereof—for HIV/AIDS, tuberculosis, and hepatitis C. The development of regional, national, or global plans, firmly grounded in science and reality, remains a fundamental aspect of TAG’s work. No less critical is effective implementation of these plans, which includes advocating for real-time adjustments to account for unanticipated epidemiological trends, emerging best medical- and service-delivery practices, unaddressed needs in heavily affected populations and geographies, evolved research agendas and prioritization, and shifting political support and funding.

We begin with an analysis of potential savings to the New York State Medicaid program that will accompany implementation of a blueprint strategy, developed by a gubernatorial task force, aimed at ending AIDS as an epidemic in NYS by the year 2020. This is followed by Kenyon Farrow’s update on the National HIV/AIDS Strategy goals for 2015 and, importantly, the need for a revitalized domestic plan that concretely addresses the first iteration’s lack of ambition and glacial pace of outcomes reporting. And though HIV vaccine and cure research and development are in early stages (and, thus, not yet driven by quantified public health targets), Richard Jefferys writes that projections for their advancement are being bandied about as a result of some notable scientific advances.

Woefully absent from the hepatitis C landscape are global elimination targets, though they are forthcoming from the World Health Organization (WHO) later this year. As Tracy Swan notes, despite astonishing therapeutic advances in recent years, surveillance data, diagnostic and monitoring optimization work, gaps in the evidence base, and access barriers have slowed goal-setting and timeline-development efforts. Finally there is the WHO’s End TB Strategy, which is striving for TB elimination by 2035. As Mike Frick reports, however, this is dependent on new tools—including new TB vaccines—being introduced no later than 2025, which requires a somewhat radical shift in vaccine research, notably an expanded focus on promising candidates in early-stage development.

As seemingly different as these aspects of TAG’s ongoing engagement in target-based strategy development and implementation may appear, they are very much united in core themes. These include unflinching support for high-caliber research, rapid and equitable scale-up of evidence-based interventions and practices, and swift, permanent razing of the structural and economic barriers that are now the greatest threat to our ability to eradicate three of the world’s deadliest diseases.