Pres. Clinton outlines need for new CD4 monitoring paradigm
October 03, 2008"In rural areas where we have funded projects specifically to deal with HIV and AIDS, we find there is simply
no such thing as an AIDS specific or an AIDS only approach. If we want to improve HIV services in rural areas, we must do more to decentralize the delivery of all kinds of quality healthcare by connecting the necessary number of quality hospitals to
clinics with trained personnel, which in turn are connected to villages through community health workers with strong ties and constant access to the people. This paradigm is focused on the most direct delivery of care possible. It is a big advance on the current model that is still in too many places requires people to travel long distances to get the care they need.
If we can turn this model around, we will relieve families from spending literally days every month traveling to
a clinic to get medicine, or provide blood samples, or get test results. In some remote communities, patients and nurses wake up as early as 3 am just to draw blood samples to send to a lab. In places where there is no electricity, they often collect samples from patients huddling under the headlights of a car. We have already seen how HIV rapid tests have revolutionized the delivery of testing and counseling. There are other transformative technologies on the horizon that can further decentralize care, particularly point of care diagnostics for CD4 and monitoring. Of course, the funding
requirements for this kind of infrastructure and staff are
significant. So we will have to raise more money and we will have to spend what we have more effectively.
In order to do that, we come to the next point I want to urge. We need more rigorous evaluation of what we are doing
and more rapid application of what we are learning. My foundation tries to keep score on everything we do. If it is
not working, we try something new. I think most of us do that. We really want to know whether the money we spend and the effort we exert have positive consequences in other people’s
lives."
