Different metrics should be used in different settings to measure ARV program success

Noting the recent publication in Science of two studies showing "the profound impact of antiretroviral-therapy coverage at a population level" -- how wider coverage can increase life expectancy and reduce the risk of HIV infection -- Grace John-Stewart, a professor at the University of Washington School of Medicine, writes in a Nature opinion piece, "These data ... should persuade policymakers to sustain or increase investment in this form of therapy." She continues, "It is clear from the two studies that for regions of high HIV prevalence, including South Africa, greater investment in antiretroviral therapy is essential. To attain one of the goals of the Joint United Nations Program on HIV/AIDS (UNAIDS) -- 15 million individuals on antiretroviral therapy by 2015 -- continued support from [the Global AIDS Program] and PEPFAR will be necessary."

"At a national or global policy level, antiretroviral therapy has been the subject of scrutiny in many ways," such as "for its dual treatment and prevention benefits" or "for the potential strain the therapy places on health systems," but "[a]ntiretroviral-therapy programs have led to broad improvements in health systems, innovations in clinical education and overhauls of laboratory and clinical infrastructure -- much more than the global community initially envisioned," John-Stewart writes. "Financial investments were linked to measurable and diverse beneficial outcomes," she notes. She concludes, "For the future, it remains important to wrestle with what outcomes are most relevant to health-resource investment decisions," saying "other metrics, including comparisons with other health investments and impact on morbidity, quality of life or productivity, may be more useful in lower-prevalence settings" (3/27).

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