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WASHINGTON – The United States is retooling its global multibillion-dollar fight against HIV/AIDS to transform healthcare in some of the world’s poorest countries, the U.S. AIDS chief said on Tuesday.

Eric Goosby, who President Barack Obama named last year to take over the Bush administration’s signature foreign aid initiative, said U.S. AIDS relief efforts must change to face a broader health crisis stretching decades into the future.

“We’ve created a very good start at what was an emergency response. We now need to move that emergency response into a sustained response,” Goosby said in an interview.

“It’s a harder lift, it’s not as flashy, it’s not as rapid in our ability to deploy and put in place. But it is more durable.”

Former President George W. Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, pledging an initial $15 billion to fight AIDS around the world.

In 2008, the Democratic-controlled Congress authorized an additional $48 billion to fight AIDS, tuberculosis and malaria, and PEPFAR now operates in some 87 countries around the world, most of them in Africa but also including China and Russia.

Goosby, who has launched a new five-year strategy for PEPFAR, said it was time to address underlying healthcare problems in AIDS-hit countries — a huge expansion of program goals — even though the immediate crisis was far from over.

“We are still responding to an emergency in no uncertain terms. It is still killing millions of people,” Goosby said.

The AIDS virus infects 33 million people globally and about a million in the United States, but more people are living longer thanks to HIV drugs — many of them supplied through PEPFAR programs, according to a recent U.N. report.

Still, more than half the people who need life-saving drugs are not getting them, the World Health Organization and Joint U.N. Program on HIV/AIDS say.

BOLSTERING GOVERNMENT RESPONSE

Despite treatment successes, Goosby said in many target countries medical systems cannot cope with the long-term burden of AIDS and other diseases, requiring new strategies to bolster healthcare programs now often run by nongovernmental organizations (NGOs).

“They are there, they are connected, but they are as ephemeral as our funding line from year to year,” Goosby said of some of the existing programs.

The next step, Goosby said, will be to emphasize national health ministries and provincial health departments, using U.S. funds to equip and train local health workers to take up more of the healthcare burden.

Services such as anti-retroviral treatment, which often are administered by NGO-run centers or provincial hospitals, must be spread throughout national medical systems stretching down to village-level clinics, he said.

“There is now a very small amount of money going from the U.S. government to ministries of health, and that will undoubtedly increase once that transparency and accountability is in place and ensured,” he said.

Goosby said this would mean PEPFAR would act more as a technical advisor rather than a purveyor of drugs — although there are plans to get anti-retroviral drugs to 1.6 million more people over the next five years on top of the 2.4 million already receiving treatment thanks to the program.

Some critics have voiced fears that the changes will undercut one of the most successful public health initiatives ever launched, and one to which the United States has already committed more than $25 billion.

Altogether, PEPFAR is credited with helping to cut AIDS deaths by 10 percent in targeted African countries and saving more than a million lives, largely through supplying the anti-retroviral (ARV) drugs that can slow but not cure the disease.

Goosby said that overall the Obama administration’s commitment to global health projects was strong, although he conceded that tight economic times meant “we’ll be arguing to address the unmet need every year in our budget discussions.”

The fiscal year 2010 budget for PEPFAR includes $5.5 billion going directly to target countries for AIDS relief, up $61 million from 2009, and $1.05 billion for the Global Fund to Fight AIDS, Tuberculosis and Malaria, another major AIDS funding agency, up $50 million from the year before.

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