Edmonton DOT for HAART: lobbying for sustainable funding as a challenging but critical aspect of effective inner city HIV management

This letter is in response
to written communication dated December 2, 2003 from the Honourable Minister of Health and Wellness, Mr. Gary G. Mar, and to recent events regarding the DOT for HAART program.
Peter Akai

DOT for HAART

Dear Mr. Wilkinson,

DOT for HAART is an innovative HIV treatment support program that was specifically designed to target and address the needs of highest risk Edmonton inner city HIV positive patients. Further to our presentation to the Standing Policy Committee on Health and Community Living, this program continued to utilise Health Innovation funding to achieve the following unprecedented and well documented results:

optimal HIV treatment adherence
effective utilisation of costly HIV medication
decreased missed appointments and reduced HIV practitioner disruption
improved health and decreased AIDS progression
decreased HIV risk behaviour and reduced potential for HIV transmission
decreased potential for emergence of HIV drug resistanc

As such, all the benefits of modern HIV management were made completely available to those who needed it most - previously untreatable HIV positive patients with the highest risk of AIDS progression, HIV transmission and drug resistance. These benefits translate into health care savings that are many times higher that the $480,000 per year required to fully sustain the program. As such, this should be attractive to provincial and federal governments interested in cost-effective innovations that reduce overall health care costs.

Unfortunately, when HIV funding expires in July 2004 most of these benefits will cease since the Capital Health Authority has only been able to offer about $85,000 (less than one fifth of the budget required) for the coming year. On a brighter note, it is understood that the Capital Health Authority may soon be able to secure additional government funding for HIV management. Accordingly, I respectfully request that $480,000 per year to re-establish an effective DOT for HAART program plus an increase to accommodate any necessary expansion be given full consideration as soon as possible.

In my estimation this is an essential approach to minimize the ongoing health burden for this highest risk population of vulnerable HIV positive individuals, the enormous HIV burden for their communities and the overwhelming economic burden for all of society. This objective opinion is based upon my observations as an infectious diseases specialist with 20 years of inner city and HIV experience and as the investigator who designed, evaluated and published the spectacular three year outcomes of the initial Edmonton DOT for HAART project.

Yours Sincerely,

Peter S. Akai MD, PhD
Medical Director
DOT for HAART program