The new HIV/AIDS program in Peru : The role of prioritizing and budgeting for results

This study aims to evaluate and develop recommendations on how the HIV/AIDS program in Peru can achieve better Value for Money. In Peru, the HIV epidemic concentrates mostly among men who have sex with men (MSM), with AIDS being the first cause of death for men ages 30-49 in 2010 and the second cause of death for women aged 25-34 (BOD, 2013). UNAIDS (2013) estimates there were 76,000 people living with HIV/AIDS (PLWA) in 2012, and this study estimates 67,000 PLWA in 2013. The Ministry of Health reports that 27,502 PLWA currently receive ART, a 43-48 percent coverage of eligible people, and 66 percent coverage of all diagnosed eligible individuals (WHO, 2013 guidelines). In 2011, there was a transition from international to domestic public funding, which increased from US$17.7 million in 2005-10 to US$57.8 million in 2011-13. The main achievements of the Peru HIV/AIDS program to date include: (i) collaboration with NGOs to provide ART; (ii) free provision of ART; (iii) educating poor women on mother to child HIV transmission; and (iv) access to reduced ARV prices through the PAHO Drug Fund. Major challenges include: (i) limited testing and laboratory capacity in the provinces; (ii) less than half of the budget is allocated to high-risk groups; (iii) wage bill issued by other programs and; (iv) limited number of community health workers (CHWs) for IEC. This study recommends targeting high-risk groups with proactive testing, promotion of condom use, and supervised ART administration by CHWs to close the coverage gap. In addition, there is a need to expand coverage of rapid testing points through greater diversity of contractual arrangements with NGOs and the private sector, which can only be achieved with the support of a human resources plan that centrally positions CHWs in HIV prevention and ARV treatment.