Dr. Themba Moeti, Managing Director, African Comprehensive HIV/AIDS Partnerships

One of the four strategic priorities of The Merck Company Foundation is improving access to quality health care and the appropriate use of medicines and vaccines. In support of this goal, the Foundation, together with the Government of Botswana and the Bill & Melinda Gates Foundation, established The African Comprehensive HIV/AIDS Partnerships (ACHAP) in 2000 to support and enhance Botswana's national response to HIV/AIDS through a comprehensive approach to prevention, care, treatment and support. It was hoped that lessons from this partnership could serve as a model to other nations in their battle against the pandemic.

The partners selected Botswana because of its position as a prime country for intervention: it had one of the highest adult prevalence rates of HIV/AIDS in the world, a viable existing health care infrastructure and a strong political will and commitment.

While success has not come overnight, progress to date is encouraging. Currently, Botswana has more than 88,000 patients on anti-retroviral therapy, with more than 1,000 new patients enrolling in the national treatment program each month. According to the World Health Organization, the country's free antiretroviral treatment program has enrolled the highest proportion of eligible patients on the African continent. Studies also have shown that the rate of new infections appears to be declining. Between 2003 and 2005, the prevalence among 15-19 year olds has declined by 22 percent, and the percentage of HIV-positive infants born to HIV-positive mothers from an estimated 40 percent at inception of the program to about 6 percent.

Here is a discussion with Dr. Themba Moeti, Managing Director, African Comprehensive HIV/AIDS Partnerships, on the value of the partnership between The Merck Company Foundation and ACHAP.

• Q: What has been the impact of the support ACHAP has received from The Merck Company Foundation?
• TM: The Foundation's support has enabled ACHAP to make a significant contribution to the national HIV/AIDS response in Botswana in the areas of:
1. Treatment, including contributing to the establishment of a national anti-retroviral (ARV) treatment program in partnership with the Botswana Government
2. Strategic support to the national response, and
3. Improvement of access to prevention and treatment services through the support of organizations involved in HIV counseling and testing and donation of HIV test kits.
• Q: How has Merck Company Foundation support helped ACHAP create sustainable solutions that address critical societal needs?
• TM: ACHAP mainly provides support to programs at the national and district level that are central to the national HIV/AIDS response and, therefore, also receive the support of Government in terms of financial, human and other resources. ACHAP support therefore leverages and catalyses national efforts. For example, the national ARV treatment program is largely funded by the government of Botswana (government funds 80 percent of the country's HIV/AIDS budget); ACHAP has supported the program by providing infrastructure, training, equipment, and resources to support the delivery of the ARV services.
  
  Much of the human resources support that ACHAP provides is done in such a way that the government can progressively absorb this newly created capacity, enhancing the sustainability of the new programs or interventions in the long term. ACHAP-supported training has helped develop local human resource capacity, which are now able to train other staff reducing the need for the type of external expertise originally required at the establishment of the program.
• Q: How has this partnership affected the people of Botswana?
• TM: The establishment of a national ARV treatment program in Botswana, to which ACHAP has contributed, has changed the face of the epidemic in Botswana, returning to productive life many people who are now able to make a positive contribution to society.
  
  ACHAP's support to the national HIV/AIDS response in Botswana continues to evolve to address emerging needs. While the most significant support thus far has been in the areas of access to treatment services, in recognition of the urgent need to rapidly scale up prevention interventions, ACHAP, with the support of The Merck Company Foundation and the Bill and Melinda Gates Foundation, has now made support for the scaling up for prevention efforts a top priority. To this end, ACHAP is supporting the development of a national plan for scaling up prevention through an effort led by the National AIDS Coordinating Agency. ACHAP will look for opportunities to strengthen support for prevention interventions in the context of this plan and, in this way, contribute to Botswana’s vision of an HIV-free generation by the year 2016.
• Q: What is the value to your organization of your partnership with The Merck Company Foundation?
• TM: The partnership of ACHAP with The Merck Company Foundation is of critical importance to ACHAP’s work. The Foundation provides 50 percent of ACHAP’s funding in a grant of US$ 56.5 million over the period 2001 to 2009 (the other 50 percent is provided by the Bill & Melinda Gates Foundation). These resources have enabled very valuable work to be done at the national level in terms of contributions to strategic components of the national response, establishment and roll out of treatment services, as well as improvement of access to treatment and prevention services by the support of HIV testing and counseling interventions in both public health facilities and non-governmental organizations.

To learn more about ACHAP, please visit our ACHAP Botswana page.