Alaina Altamura – Clinton Health Access Initiative, Senior Manager, Advanced HIV Disease
In 2023, 630,000 people died from AIDS-related illnesses worldwide, highlighting a significant gap between global targets and the realities on the ground. The Unitaid-Clinton Health Access Initiative (CHAI) advanced HIV disease (AHD) partnership, formed in 2019, has been a key player in addressing this gap by shaping the global response, supporting national programs, and catalyzing the market for AHD treatments.
To coordinate these efforts, Unitaid and CHAI established the AHD Implementation Steering Committee (AHD ISC), which brought together representatives from key partner organizations in the AHD space. This platform played a critical role in aligning the work of implementers and funders while enabling experts to support and inform the program implementation of Unitaid’s AHD investment.
In 2023, the AHD ISC expanded its scope and was renamed "The AHD Alliance" to better reflect its evolving mission, which was now far broader than program implementation alone. The current iteration of the AHD Alliance includes a wider geographical focus beyond Africa—reaching regions including Latin America and Southeast Asia. It also has a greater emphasis on the community and tackles additional AIDS-related illnesses. Today, the AHD Alliance has over 70 active members across 29 partner organizations.
This past December, CHAI had the opportunity to sit down with AHD Alliance co-chairs Tom Chiller (Chief of the Mycotic Diseases Branch, United States Center for Disease Control) and Nathan Ford (Scientific Officer and Guidelines Review Committee Chair, World Health Organization) to reflect on the AHD Alliance's progress over its first five years and discuss the forum's future as we work towards the 2030 targets for ending AIDS.
How would you describe AHD stakeholder collaboration before and after Unitaid’s AHD investment and the AHD Alliance?
TC: As we all know, the AHD ecosystem hasn’t always existed coherently. Many groups were working in a piecemeal fashion, often with disease-specific efforts that did not focus on AHD as a whole. The idea of bringing people together from multiple institutions, agencies, and implementing partners to address this challenge was groundbreaking. Before the Unitaid program and investment in AHD, CDC and others were engaged in the space, but it was a more fragmented approach. Unitaid’s investment really served as a catalyst, demonstrating that global funders were interested and could generate momentum. Organizations like PEPFAR, the Global Fund, and other big funders are now paying more attention to AHD and getting involved in funding it, which is crucial for saving lives.
NF: As Tom noted, before the Alliance, a number of important activities were happening, but they were often haphazard, with little appreciation of possible synergies among the range of AHD projects. At times, it could be difficult to harness the energy of multiple actors, and some efforts ended up being duplicative. There was no place where these activities could be shared, and it was not obvious how we could come together and collaborate more effectively.
What would you say have been the greatest impacts of having the AHD Alliance?
TC: The first and most important impact of this type of alliance or working group is communication. It opens lines of communication between a diverse group of stakeholders. This has been critical because it allowed us to learn from each other and engage in meaningful conversations about the challenges faced by AHD patients.
The second impact is the formation of new partnerships. Groups began to realize they were working in the same countries, often on overlapping issues, and there was a need to work together. Doing more with less was a key takeaway. This collaboration also allowed us to advocate more effectively, generating progress on initiatives like writing guidance that supports the AHD space. We can't make real progress without the correct diagnostics and treatments in guidelines, so this streamlined advocacy is critical.
NF: Bringing people together supports collaboration, reduces the risk of duplication, and identifies key gaps that need addressing. To give one example and elaborate on Tom’s earlier point, thanks to discussions at AHD Alliance meetings, it became apparent that more guidance was needed to address AHD in the hospital setting. In response, WHO produced a policy brief on providing care for people with advanced HIV who are seriously ill. This is an important first step towards further attention and support for this high-risk population, including research to identify what works in this population to reduce mortality.
TC: There’s still much work to be done in implementation, and clearly, Unitaid’s support has been a huge factor in driving that forward. The Global Fund and PEPFAR are now facilitating some of this, and we're hopeful that WHO will also engage further to help with advocacy and move the needle on things like the utility of CD4 testing. Overall, the AHD Alliance is playing a central role in advancing the agenda.
How does this work positively impact AHD patients?
TC: Ultimately, our goal is to save lives. What we’ve come to learn in the AHD space is that while the initial focus was often on new patients recently diagnosed with AHD, many AHD patients are actually reinitiating care after falling out of care. In fact, data now shows that in some countries, 70% of AHD patients are reinitiating care. This group had been largely overlooked in the past.
The Alliance helped to shift the conversation and advocate for the recognition that reinitiating care is just as critical as addressing new patients. As a result, we've helped countries and organizations see the importance of including these patients in care packages and developing guidance that accounts for both new and reinitiating patients.
NF: Exactly. Increased awareness of the ongoing challenges around providing care for people living with advanced disease is an important first step towards more action and resources to support this vulnerable population and ultimately save lives. Work done under the AHD Alliance provides countries with better guidance, which is crucial for translating AHD work into country-level implementation. Once there’s a national plan, it’s easier for countries to scale up services and provide comprehensive support to patients.
TC: While the Alliance itself may not directly interface with patients, the work being done by the groups within the Alliance, many of which are implementing partners, is making a real difference on the ground.
What are your hopes for the AHD Alliance over the next few years?
TC: Nathan and I have often talked about continuing to seize the moment. In public health, some things rise in popularity but then they fade. For this reason, over the last few years, we’ve been focused on making sure we keep pushing the AHD agenda forward, particularly within HIV programs. While the most important aspect of HIV programs is ARVs, we still have a population of patients suffering from AHD, where we can save lives and ensure they’re connected to care.
In the next few years, we need to focus on further integrating AHD care into HIV programs at the country level. This means helping write guidelines and ensuring countries have access to the necessary medications and commodities. We’ll need to tailor logistics to each country’s unique needs and health infrastructure while also considering building stronger public-private partnerships.
NF: Agreed. The hope is to continue to expand, bringing in a broad range of representation and perspectives, and achieve concrete actions that will make a positive difference in people's lives. This also includes establishing forums that focus on underserved groups like children, which we have already spearheaded by supporting the founding of the Pediatric Advanced HIV Disease Committee, organized under the larger AHD Alliance umbrella.
The success of the AHD Alliance signals a growing momentum and efficiency in the global response. By deepening collaboration, expanding the scope of the work, and embracing innovation, there is hope that the target of ending AIDS by 2030 remains within reach. The work continues, and the world must remain united in this essential mission.
 For inquiries regarding the Advanced HIV Disease Alliance, please reach out to Alaina Altamura aaltamura@clintonhealthaccess.org.