HIV/AIDS Treatment improves in Moldova

Moldova is a low–income country with 3.8 million people who have a per person income of about US$1,260, well below their neighbors in the region. Following independence from the Soviet Union in 1991, the country suffered a massive economic shock. As a result, government public expenditure dropped, including for health. Consequently, service and quality suffered. Life expectancy at 68 years of age was one of the lowest in Europe. Maternal and infant mortality rates stabilized at 3 to 5 times higher than European Union averages. In the late 1990s, the incidence of TB increased dramatically, especially in prisons. From the mid-1990s onward, HIV/AIDS prevalence increased by more than 25 times among the 15-49 age group, reaching 0.9 percent in 2003. Resources were skewed toward large Soviet-era hospitals, which represented 70 percent of health spending.

The IDA-financed Health Investment Fund Project was launched in 2000 to upgrade emergency and primary health care, downsize and consolidate excessive capacity, and develop institutional capacity and policies. The project also established the Health Investment Fund to stimulate change by demonstrating improvements in access, quality, and efficiency of health care services at all levels of the system. Subsequently, the IDA-financed AIDS Control Project was launched in 2003 to provide strategic planning and institutional capacity building for HIV/AIDS and sexually transmitted infections (STI) control; scale up prevention interventions for HIV/AIDS/STI and STI management; and improve treatment, care, and support for people living with AIDS through managing opportunistic infections and palliative care, home and community-based care and support, and highly-active anti-retroviral therapy.

Reforms achieved with support from the Health Investment Fund Project included achieving efficiencies in the sector by reducing unnecessary infrastructure and ancillary spending, and approving a financing framework to shift resources from the hospital sector to primary health care and emergency care. Since 1992, the excess health infrastructure in Moldova shrunk from over 300 hospitals to 65 — a restructuring effort which is unprecedented in any country in the region, resulting in over US$10 million in savings annually or about 25 percent of publicly financed health spending.

In addition, the project supported the development of a legal framework for health sector reforms and financing, including the development of a basic package of health care services and TB and AIDS strategies.

Life expectancy of HIV-infected people stabilized, HIV mother-to-child transmission decreased more than 90 percent, and HIV transmission rates among youth and injecting drug users dropped.

Highlights:
- Access increased for pregnant women. All pregnant women were provided access to HIV screening, as well as pregnant women diagnosed with HIV to prophylactic treatment with anti-retroviral therapy. Also, they were provided free milk formula for replacement feeding.

- Mother-to-child transmission decreased. Mother-to-child transmission of HIV infection decreased by more than 90 percent — from 20 percent in 2002 to 1.7 percent in 2007.

- Rates stabilized. HIV incidence in Moldova’s population stabilized at 14.6 per 100,000. HIV prevalence among injecting drug users in Moldova significantly decreased from 16 per 1,000 tested in 2002 to 8.6 per 1,000 tested in 2008. (Moldova figures do not count the Transnistria region). Over 12,000 injecting drug users were covered with comprehensive harm-reduction services.

- Monitoring and evaluation. The epidemic was monitored by a newly established data system, which provides timely and comprehensive information to decisionmakers.

- Syphilis prevalence decreased. Syphilis prevalence decreased from 94.8 per 100,000 in 2002 to 74.2 in 2007.

IDA contributed US$10 million of the total US$22.6 million for the Health Investment Fund Project, and US$5.5 million for the AIDS Control Project. Both projects supported the Government’s objectives and built on IDA’s experience in health sector reform and HIV-control throughout the Europe and Central Asia Region.

The First Health Sector and HIV/AIDS Control Strategy, developed by the Government, IDA, the Netherlands, and SIDA, helped the government set evidence-based policy directions and provide a framework for coordinating donor assistance in the sector. Furthermore, the initial IDA credit allowed the country to raise additional grant funding to prepare a strategy that became the basis for implementation of the National AIDS Program, co-financed by IDA; the Global Fund to Fight Aids, Tuberculosis, and Malaria; Sweden; and other sources. The Health Investment Fund project was co-financed with the Netherlands Government, which contributed US$10 million, an amount equal to the IDA contribution. Technical assistance and investment support was provided jointly by the World Health Organization, UNAIDS, Council of Europe Development Bank, and other donor and technical agencies. A grant from the Japan Social Development Fund was provided to prevent hepatitis-B in Moldova.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria stepped up its support to Moldova’s National HIV/AIDS Program following the conclusion of IDA’s AIDS Control Project in 2008. The state budget contribution is expected to cover approximately 31 percent of total HIV program costs in 2008-2010. Overall financial sustainability of HIV programs remains a challenge. The next phase of IDA support will address these challenges within the context of the ongoing IDA-financed Health Services and Social Assistance Project, which launched in 2008.

Source: http://web.worldbank.org