Informe OMS - Sida Paraguay

Evaluación para el
fortalecimiento de la respuesta
del sistema de salud
al VIH en Paraguay
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Qa Conocer más profundamente la epidemia de VIH 47 4< K;:;GH;FN /C ;C>CK<J: >@BH8C;DC8 E@K
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:a Mejorar los sistemas de vigilancia epidemiológica DC :>FC8D@ >@; E@K :G:;>CK

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ii) RECTORÍA Y GOBERNANZA
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Recomendaciones
kh Reponer la total responsabilidad de la rectoría en materia de la respuesta al VIH y el sida

al MSP y BS2 M: gFC lKJ: EC >@88CKH@;DC >@;>CHJF:E M Jl>;<>:BC;JC :E ,<;<KJC8<@ DC /:EFDN
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lh Apoyar el proceso de reglamentación de la recientemente promulgada Ley que establece

los derechos, obligaciones y medidas preventivas con relación con los efectos producidos
por el virus de Inmunodeficiencia Humana (VIH) y el Síndrome de la Inmunodeficiencia
Adquirida (sida), >@; CE H8@H?K<J@ DCP
:N %KC9F8:8 E: 8C>J@8X: DCE ,<;<KJC8<@ DC /:EFD M 4<C;CKJ:8 /@><:E C; CE H8@>CK@ DC

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J8:GlK DCE +8@98:B: &:><@;:E DC )@;J8@E DCE /<D:^'W/ `+#"&%/'.%a2 DChC
>@;KC8G:8 KF 8@E 8C>J@8N
hN -; :JC;><?; : E@ :;JC8<@8 E: ;C>CK<D:D DC gFC E: 8C9E:BC;J:><?; 8CK>:JC E: dF;><?;
8C>J@8: DCE ,<;<KJC8<@ DC /:EFD M 4<C;CKJ:8 /@><:E KC b:>C ;@J@8<: C; :KHC>J@K
>@B@P
<N 0: :8J<>FE:><?; DC E: Respuesta Nacional gFC KC <;KJ8FBC;J: : J8:GlK DCE
+#"&%/'.%N
<<N 0: CB<K<?; DC E:K ;@8B:K H:8: E: CKJ8F>JF8:><?; DC E@K H8@98:B:K DC
>:H:><J:><?;2 K< h<C; >@;J:;D@ >@; E: :KCK@8X: Jl>;<>: gFC H:8: E@K CdC>J@K
EC h8<;DC CE +#"&%/'.%N
<<<N -E CKJ:hEC><B<C;J@ DC E@K >C;J8@K DC 8CdC8C;><: M >@;J8: 8CdC8C;><:2 J:;J@
C; E:K K<JF:><@;CK DC G<@EC;><: KCeF:E >@B@ C; >F:;J@ : E: :JC;><?;
<;JC98:E DC K:EFD2 >@; CE @hfCJ@ DC 9:8:;J<=:8 E: <;JC98:><?; DC E: 8CD DC
KC8G<><@K H:8: E: CdC>J<G<D:D DC E:K 8CKHFCKJ:KN
<GN 0:K 9:8:;JX:K DC >FBHE<BC;J@ DC E@K H8<;><H<@K lJ<>@K C; CE TBh<J@ DC E:
<;GCKJ<9:><?; C; E:K B:JC8<:K @hfCJ@ DC E: 0CMN
GN W@D@ @J8@ <;G@EF>8:D@ C; CE CfC8><><@ DC E:K dF;><@;CK gFC EC >@BHCJC; C;
8CE:><?; C;J@8;@ : E@K @hfCJ<G@K DC E: 0CM >@B@ H@EXJ<>: DC -KJ:D@N
mh Ir a un proceso de rediseño de PRONASIDA para avanzar hacia una respuesta de país al
VIHN /@h8C E: h:KC DC E@K H8@>CK@K DC 8C@89:;<=:><?; M b@8<=@;J:E<=:><?; H8@98:BTJ<>:
<BHFEK:D@K H@8 CE ,/+ M 4/2 E:K @8<C;J:><@;CK CKJ8:Jl9<>:K DCd<;<D:K C; CE D@>FBC;J@
v+@EXJ<>:K +khE<>:K H:8: E: ):E<D:D DC 3<D: M /:EFD >@; -gF<D:D !55RO!5Q7p M E@K 8CKFEJ:D@K
DC E: H8CKC;JC CG:EF:><?;N
QS
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
nh Avanzar en la separación de los roles normativos y de asistencia en PRONASIDAN -KJ@

HFCDC >:B<;:8 C; F; H8@>CK@ H8@98CK<G@ DC <;JC98:><?; dF;><@;:E DC E:K :>J<G<D:DCK DC E@K
/C8G<><@ DC %JC;><?; ';JC98:E2 /%'2 C; E@K >C;J8@K C; E@K gFC @HC8:;2 CE E:h@8:J@8<@ >C;J8:E2
E: d:8B:><:2 C;J8C @J8@KN
oh Desarrollar en PRONASIDA un enfoque de gestión centrado en las personas y sus
derechos, y basado en los resultados y en el impacto de las acciones que se realizanN
ph Desarrollar una política integral de recursos humanos*en salud*gFC <;>EFM: d@8B:><?; 3'L
M K<D:2 E:K 8CKH@;K:h<E<D:DCK M E@K DC8C>b@K DC FKF:8<@K M DCE HC8K@;:E2 J8:;KH:8C;><: M
CgF<D:D C; CE BC>:;<KB@ DC :>>CK@ M K:E:8<@KN 0: :>JF:E H@EXJ<>: DC >@;J8:J:><?; DC
HC8K@;:E D<8C>J: H@8 +#"&%/'.% gFC ;@ KC <;JC98: : E: HE:;J: b@KH<J:E:8<: M >@; K:E:8<@K
D<dC8C;JCK2 8CKFEJ: C; F; DCJC8<@8@ DCE :Bh<C;JC E:h@8:E2 H@;C D<d<>FEJ:DCK :E H8@>CK@ DC
<;JC98:><?; DC E:K :>J<G<D:DCK DC 3'L : E@K KC8G<><@K DC K:EFD M 8CDF>C E: H8@h:h<E<D:D DC <8
: F;: 8CKHFCKJ: K@KJC;<hECN
iii) PREVENCIÓN
0: H8CGC;><?; DC E: J8:;KB<K<?; DCE 3'L b: :G:;=:D@ C; CE HC8X@D@ !55U [ !5562 <;>@8H@8T;D@KC
:>J<G<D:DCK H:8: E: H8CGC;><?; DC E: J8:;KB<K<?; B:JC8;@<;d:;J<E DCE*3'L*g+W,'hB C; H@hE:><@;CK C;
B:M@8 8<CK9@N /<; CBh:89@2 E: JC;DC;><: DC E:K ;FCG:K <;dC>><@;CK OH:8J<>FE:8BC;JC C; E:
H@hE:><?; :D@ECK>C;JC M f@GC;O b:>C ;C>CK:8<@ :FBC;J:8 E: CK>:E: DC E:K :>><@;CK H8CGC;J<G:K
<;>EFMC;D@ : E:K H@hE:><@;CK GFE;C8:hECK M BCf@8:8 E: >:E<D:D DC E:K B<KB:KN .CE J@J:E DC >:K@K
;@J<d<>:D@K DC 3'L C;J8C C;C8@ M :9@KJ@ DC !5562 CE V5s >@88CKH@;DC :E 98FH@ CJ:8<@ DC QU O !6
:i@K2 M CE USs DC CEE@K K@; BFfC8CK6N 0: 8CKHFCKJ: C; H8CGC;><?; CK d8:9BC;J:D: M ;@ >@;K<DC8:
E@K d:>J@8CK DCJC8B<;:;JCK K@><@>FEJF8:ECK2 KCeF:E<D:D M 9l;C8@N W<C;C h:f: >@hC8JF8: 8CE:J<G: M
CK>:K@ d<;:;><:B<C;J@ ;:><@;:EN 0: CKJ8:JC9<: DC H8CGC;><?; CKJT DCJC8B<;:D: H@8 E@ >@;>C8J:D@
>@; CE I@;D@ ,F;D<:EN
Recomendaciones
kh Rediseño de la estrategia de prevención H:8: F;: 8CKHFCKJ: CdC>J<G: M K@KJC;<hEC CK

F89C;JC F; 8CD<KCi@ DC E: CKJ8:JC9<: DC H8CGC;><?; gFC d@8J:EC=>: M :BHEXC CE J8:h:f@ >@;
+-,%# M E:K H@hE:><@;CK GFE;C8:hECK2 BCf@8C E: Cd<><C;><:2 D<KH@;9: DC 8C>F8K@K
;:><@;:ECK2 :FBC;JC E: >@hC8JF8: DC +W,' M CE :>>CK@ M H8@B@><?; DC F;: @dC8J: 98:JF<J:
DC E: H8FCh: DC 3'L : E: H@hE:><?;N
lh Integrar la oferta de la prueba como un elemento esencial en todos los servicios de
salud. %>JF:EBC;JC CKJ:K :>J<G<D:DCK KC 8C:E<=:; K@E:BC;JC C; E@K >C;J8@K gFC D<KH@;C;
DC /%'K2 M C; CE >:K@ DC 'W/ M DC E: H8CGC;><?; DC E: J8:;KB<K<?; B:JC8;@<;d:;J<E DCE 3'L
`+W,'a K@E:BC;JC C; E@K >C;J8@K gFC >@;>C8J:8@; CKJ:K :>J<G<D:DCK >@; +#"&%/'.%N -KJ@
8CKFEJ: C; F; \Us DC d:EJ: DC :>>CK@ : E: H8FCh: DCE 3'L C; BFfC8CK CBh:8:=:D:K2 B:M@8
:k; C; T8C:K ;@ H8<@8<=:D:K H:8: E@K H8@MC>J@K DCE I@;D@ ,F;D<:EN ';>EFK@ C; >C;J8@K
9
+#"&%/'.%N +8CKC;J:><?; 8C:E<=:D: :E CgF<H@ DC CG:EF:><?; DC "+/N R ;@G<CBh8C !556N
QR
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
D@;DC dF;><@;:; /%'K KC DCJC>J? E: d:EJ: DC :>>CK@ : E: +W,' M : H8@d<E:e<K H@KJ CeH@K<><?;
C; b@8:8<@ ;@>JF8;@ @ d<;CK DC KCB:;:N
mh Mejorar y profundizar el conocimiento sobre factores determinantes del VIH2 C;J8C CEE@K
E@K K@><@>FEJF8:ECK2 KCeF:E<D:D M 9l;C8@u DC B:;C8: DC :KC;J:8 C; CKC >@;@><B<C;J@ C
<;d@8B:><?;2 E@K H8<;><H<@K2 E:K H@EXJ<>:K M E:K CKJ8:JC9<:K DC H8CGC;><?; :E 3'LN
\a Fortalecer la participación de la sociedad civil en la prevención del VIH M ;@ K?E@ C;
>:E<D:D DC CfC>FJ@8CK DC :>J<G<D:DCK DC H:8CK K<;@ J:Bh<l; >@B@ :>J@8CK DCE D<KCi@ M
CfC>F><?; DC E: H@EXJ<>: M CKJ8:JC9<:K DC H8CGC;><?;N
Ua Prevención secundaria en personas con VIHN .<KCi:8 C <BHECBC;J:8 F;: H@EXJ<>: M
CKJ8:JC9<:K DC H8CGC;><?; KC>F;D:8<: C; HC8K@;:K >@; 3'L2 H:8: CG<J:8 E: J8:;KB<K<?; M E:
8C<;dC>><?; DC CKJ: H@hE:><?;N
Va Evaluar las acciones diseñadas e implementadas DCKJ<;:D:K : :dC>J:8 E: <;><DC;><: DCE
3'LN
Sa Internalizar el enfoque de derechos y de género C; E:K :>J<G<D:DCK DC H8CGC;><?;N
iv) Atención y tratamiento
-E H:XK >FC;J: >@; F; B@DCE@ DC :JC;><?; <;JC98:E >@;>CHJF:EBC;JC :DC>F:D@N 0: <BHECBC;J:><?;

DC CKJC B@DCE@ b: HC8B<J<D@ E@98:8 <BH@8J:;JCK :G:;>CK C; E: H8@G<K<?; DC KC8G<><@KN -; CE HC8<@D@
DC !55U : !556 <;<><:8@; J8:J:B<C;J@ !NQ75 HC8K@;:KN /<; CBh:89@2 E: @89:;<=:><?; DC E: :JC;><?;
b: K<D@ >@;KJ8F<D: C; d@8B: DCK:8J<>FE:D: M DFHE<>:;D@ KC8G<><@K C; E@K >C;J8@K DC K:EFD M
b@KH<J:ECK `d:8B:><:2 E:h@8:J@8<@2 HK<>@E@9X:2 @J8@KaN 0: d@8B: C; gFC KC B:JC8<:E<=: E: :JC;><?; ;@
>@;J8<hFMC : C;J8C9:8 F;: H8CKJ:><?; DC >:E<D:D2 DCKd:G@8C>C CE d@8J:EC><B<C;J@ DC E: 8CKHFCKJ: :E
3'L C; CE KC>J@8 K:EFD2 E<B<J: E: CeH:;K<?; M >@BH8@BCJC E: K@KJC;<h<E<D:D C; CE E:89@ HE:=@N
Recomendaciones
kh Modificar el rol de PRONASIDA H:8: gFC KC >@;>C;J8C Oh:f@ E: @8<C;J:><?; DCE ,/+ M 4/ >@B@
C;JC 8C>J@8 DCE KC>J@8 K:EFDO C; E: DCd<;<><?; DC H@EXJ<>:K M CKJ8:JC9<:K2 :>J<G<D:DCK ;@8B:J<G:K2
E: HE:;<d<>:><?; M CE >@;J8@E DC >:E<D:D DC E: H8@G<K<?; DC KC8G<><@K M DCfC E: dF;><?; DC
:K<KJC;><: gFC >@88CKH@;DC : E@K KC8G<><@K DC K:EFDN
lh Reorganizar los SAIs H:8: <;<><:8 F; H8@>CK@ DC <;JC98:><?; dF;><@;:E DC E:K :>J<G<D:DCK DC E@K
/%'K C; E@K CKJ:hEC><B<C;J@K DC K:EFD C; gFC @HC8:;N
mh No crear nuevos SAIs con la modalidad organizativa que se da actualmente.
nh Desarrollar una estrategia integrada con los otros programas de salud existentes
`:D@ECK>C;><:2 K:EFD KCeF:E M 8CH8@DF>J<G:2 C;J8C @J8@Ka H:8: gFC HFCD:; KC8 J:Bh<l;
CdC>J@8CK DC :>J<G<D:DCK DC H8@B@><?;2 H8CGC;><?; M D<:9;?KJ<>@ M :JC;><?; DC 3'L2
<DC:EBC;JC C; CE H8<BC8 ;<GCE DC :JC;><?;N -K DC H:8J<>FE:8 8CECG:;><: b:>C8 CdC>J<G@ CE
:>FC8D@ DC >@E:h@8:><?; C;J8C E@K H8@98:B:K DC 3'L M W4) : d<; DC :KC9F8:8 E: @dC8J:
D<:9;@KJ<>: DC 3'L C; E@K H:><C;JCK >@; W4)2 E: H8CGC;><?; DC E: W4) C; H:><C;JCK 3'L2 M
d:><E<J:8 CE J8:J:B<C;J@ :;J<88CJ8@G<8:E @H@8JF;@ C; CKJ@K H:><C;JCK2 DC :>FC8D@ >@; E:
CKJ8:JC9<: 7< DC E: ",/N
Q6
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
oh Actualizar y optimizar los procesos normativos de las guías terapéuticasN -K <BH8CK><;D<hEC

CKJ:hEC>C8 F; BC>:;<KB@ H:8J<><H:J<G@ gFC :KC9F8C E: HFCKJ: :E DX: C <;>EFK<?; DC E: CG<DC;><:
8C><C;JC : ;<GCE <;JC8;:><@;:E M KF :DC>F:><?; : E: K<JF:><?; ;:><@;:EN -K F89C;JC 8CG<K:8 E:K
9FX:K :>JF:ECK2 gFC D<d<>FEJ:; E: dF;><?; @8<C;J:D@8:N 0: d:EJ: DC >E:8<D:D C; E:K
8C>@BC;D:><@;CK DC J8:J:B<C;J@ DC KC9F;D: EX;C: HFCDC KC8 F;: E<B<J:;JC H:8: E: <;JC98:><?;
DC E: :JC;><?;N
ph D6:B;<434: <; 3;P;38>;> >4 >43858?7 >4 <65 4QH8P65 B:;B;7B45 47 <65 7894<45 :4G867;<45 F
<63;<45M -E :EJ@ 98:D@ DC >C;J8:E<=:><?; DCE H8@>CK@ DC J@B: DC DC><K<@;CK K@h8C>:89: CE ;<GCE
>C;J8:E M E<B<J: E: >:H:><D:D E@>:EN /C 8C>@B<C;D: BCf@8:8 CE H8@>CK@ ;@8B:J<G@2 d@8J:EC>C8 E:K
:>J<G<D:DCK DC C;J8C;:B<C;J@ M DC CDF>:><?; >@;J<;F: H:8: gFC E:K DC><K<@;CK : ;<GCE E@>:E KC
HFCD:; EECG:8 : >:h@ C; d@8B: CdC>J<G: M @H@8JF;:N
qh Mejorar los niveles de adherencia y la retención de los pacientesN -K ;C>CK:8<@ 8C>@EC>J:8 M
H8@>CK:8 E: <;d@8B:><?; >EX;<>: K@h8C E@K ;<GCECK DC :DbC8C;><:2 >@BH8C;DC8 E@K d:>J@8CK gFC
EECG:; :E :h:;D@;@ M D<KCi:8 <;JC8GC;><@;CK H:8: E@>:E<=:8 M 8CO>:HJ:8 E@K H:><C;JCK2 C;
H:8J<>FE:8 H8@B@G<C;D@ CE <;G@EF>8:B<C;J@ DC E:K :K@><:><@;CK DC H:><C;JCKN %DCBTK2 BCf@8:8
E: HE:;<d<>:><?; M E: E@9XKJ<>: H:8: :KC9F8:8 CE KFB<;<KJ8@ >@;KJ:;JC2 8C>@EC>J:8 M H8@>CK:8 C;
d@8B: K<KJCBTJ<>: E: <;d@8B:><?; DC d:8B:><: M DCBTKN
rh Considerar integrar el laboratorio de referencia de PRONASIDA en el laboratorio 347B:;<N 0:
>8C:><?; DC F;: KC>><?; DC G<8@E@9X: C; CE E:h@8:J@8<@ ;:><@;:E DC 8CdC8C;><: HC8B<J<8X:
@HJ<B<=:8 8C>F8K@K M :H8@GC>b:8 E:K 8CDCK Ce<KJC;JCK DC DC8<G:><?;N
sh Asegurar el compromiso y la participación de los otros actores en la provisión de serviciosR :
d<; DC :KC9F8:8 :>>CK@ M :E<;C:><?; DC >8<JC8<@K DC <;<><@ M CKgFCB:K DC J8:J:B<C;J@ `C;
H:8J<>FE:8 >@; CE ';KJ<JFJ@ DC +8CG<K<?; /@><:E2 CE KC>J@8 H8<G:D@2 CE K<KJCB: >:8>CE:8<@aN*
kth Perfeccionar los procesos de análisis y devolución de la información estratégica de la
atención. -K ;C>CK:8<@ gFC E:K 8C9<@;CK M >C;J8@K DC K:EFD D<KH@;9:; DC E: <;d@8B:><?;
CKJ8:Jl9<>: H8@>CK:D: : H:8J<8 DC KFK D:J@K M 8CH@8JCK2 H:8: :E<BC;J:8 KFK H8@>CK@K DC
HE:;<d<>:><?; M CeHE<>:8 E: JC;DC;><: DC E: C;dC8BCD:D `C; H:8J<>FE:8 E: H8CG:EC;><: C;
H@hE:><@;CK >E:GC M C; B@8J:E<D:D2 >FM: ><d8: KC b: B:;JC;<D@ >@;KJ:;JC C; E@K kEJ<B@K 7 :i@K
C; :H8@e<B:D:BC;JC Q\5 >:K@K :E :i@aN
v) Gestión de Abastecimiento
0: CG:EF:><?; DCE T8C: DC $CKJ<?; DC %h:KJC><B<C;J@ >@;K<DC8? J8CK D<BC;K<@;CKP )@BH8:K2

+E:;<d<>:><?; DC %DgF<K<><@;CK M E: %K<9;:><?; DC #C>F8K@KN -E :;TE<K<K M >@;>EFK<@;CK BFCKJ8:; gFC
Ce<KJC; @H@8JF;<D:DCK K<9;<d<>:J<G:K H:8: BCf@8:8 E: 9CKJ<?; C; >:D: F;: DC E:K J8CK T8C:K
:;:E<=:D:KN -; CE T8C: DC >@BH8:K2 Ce<KJC F;: @H@8JF;<D:D <;BCD<:J: H:8: BCf@8:8 E: 8C;J:h<E<D:D
K@><:E DC E: <;GC8K<?; C; 3'LN +:8:9F:M >@BH8: E@K %#3K : H8C><@K gFC K@; DC ! : BTK DC U5 GC>CK
KFHC8<@8CK >@BH:8:D@K >@; E:K 8CdC8C;><:K DC H8C><@K >@BHCJ<J<G@K <;JC8;:><@;:ECK2 : gFC E:
B:M@8X: DC E@K H:XKCK DC E: 8C9<?; :>>CDCN )@;K<DC8:;D@ E:K >:;J<D:DCK M H8C><@K CKJ<B:D@K H:8:
E:K >@BH8:K DCE ,/+ M 4/ DC E@K kEJ<B@K BCKCK2 E:K 8CDF>><@;CK H@K<hECK <;BCD<:J:K KFHC8:; CE
V5sN 1;: K<JF:><?; H:8C><D: @>F88C >@; E:K H8FCh:K DC ).\ M ):89: 3<8:EN /C b:>C ;C>CK:8<@ M
!5
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
F89C;JC >:Bh<:8 E:K BCJ@D@E@9X:K DC >@BH8:2 DCK:88@EE:8 C <BHECBC;J:8 F;: CKJ8:JC9<: DC 9CKJ<?;
:>J<G: DC 8CDF>><?; DC H8C><@K C; h:KC : E: <DC;J<d<>:><?; M 9C;C8:><?; DC :EJC8;:J<G:K DC H8@G<K<?;
>@BHCJ<J<G:KN +:8:ECE:BC;JC2 d@8J:EC>C8 E:K >:H:><D:DCK DC HE:;<d<>:><?; M K<KJCB:J<=:><?; DC E:
CKJ<B:><?; DC E: DCB:;D: M E: H8@98:B:><?; d<;:;><C8: BFEJ<:;F:EN
Recomendaciones
kh Iniciar inmediatamente gestiones de compras de ARVs (F 6B:65 E4>83;E47B65 F P:H4L;5

:SP8>;5T a través de un agente de compras internacionalN
lh Implementar una estrategia de promoción de la competencia y reducción de precioN
.CK:88@EE:8 M >@BC;=:8 : <BHECBC;J:82 : H:8J<8 DC !5Q52 F;: CKJ8:JC9<: `DC >@8J@2 BCD<:;@ M
E:89@ HE:=@a DC H8@B@><?; DC E: >@BHCJC;><: M 8CDF>><?; DC H8C><@KN -KJ: DChC <;>EF<8 E:
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Aunque la información actualmente disponible no muestra una imagen exacta de la

situación epidemiológica, se puede clasificar a la epidemia como una epidemia
concentrada en grupos poblacionales en mayor riesgo.
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27
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El diseño de los estudios y vigilancias epidemiológicas previas limitan su comparabilidad

y representatividad
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La prueba de VIH en poblaciones en mayor riesgo supera levemente el 50% de las

personas susceptibles de hacerla.
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Es necesario conocer el tamaño de las poblaciones en mayor riesgo
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La información sobre mortalidad por sida es y está muy limitada
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Prevalencias de ITS, una situación preocupante que contrapuntea con avances frente al
VIH y el sidaN
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Hay grupos poblacionales que no han sido abordados por estudios epidemiológicos
nacionales
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Los sistemas de vigilancia, monitoreo y evaluación del MSP y BS están fragmentados y

no articulados
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La notificación es una importante debilidad estratégica del sistema de vigilancia del VIH
y el sida
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Es necesario priorizar y agilizar la incorporación de bases de datos electrónicas para el

buen manejo de la información en PRONASIDA
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Insuficiente información disponible afecta la calidad y profundidad de los informes de

avance del país a organismos internacionales
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PRONASIDA cumple una función rectora, normativa y de provisión
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El diseño de gestión de PRONASIDA está insuficientemente centrado en las personas, los

resultados e impacto de las acciones.
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Un diseño de organigrama de PRONASIDA desmedido si se compara con el tamaño de la

epidemia en el país y la necesidad de articular una respuesta interprogramática.
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La nueva ley de sida que modifica la anterior 102/91 es ambigua en asignar el rol rector
a la autoridad sanitaria nacional y podría validar los roles de rectoría y de provisión de
PRONASIDA.
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La función de recursos humanos presenta debilidades.
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kh Reponer la total responsabilidad de la rectoría en materia de la respuesta al VIH y el sida

al MSP y BS2 M: gFC lKJ: EC >@88CKH@;DC >@;>CHJF:E M Jl>;<>:BC;JC :E ,<;<KJC8<@ DC /:EFDN
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lh Apoyar el proceso de reglamentación de la recientemente promulgada “Ley que establece

los derechos, obligaciones y medidas preventivas con relación con los efectos producidos por
el virus de Inmunodeficiencia Humana (VIH) y el Síndrome de la Inmunodeficiencia Adquirida
(sida)”, >@; CE H8@H?K<J@ DCP
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>@;KC8G:8 KF 8@E 8C>J@8N
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8CE:><?; : E@K @hfCJ<G@K DC E: 0CM >@B@ H@EXJ<>: DC -KJ:D@N
mh Ir a un proceso de rediseño de PRONASIDA para avanzar hacia una respuesta de país al VIHN
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CG:EF:><?;N
\a Avanzar en la separación de los roles normativos y de asistencia en PRONASIDAN -KJ@ HFCDC
>:B<;:8 C; F; H8@>CK@ H8@98CK<G@ DC <;JC98:><?; dF;><@;:E DC E:K :>J<G<D:DCK DC E@K /C8G<><@ DC
%JC;><?; ';JC98:E2 /%'2 C; E@K >C;J8@K C; E@K gFC @HC8:;2 CE E:h@8:J@8<@ >C;J8:E2 E: d:8B:><:2
C;J8C @J8@KN
Ua Desarrollar en PRONASIDA un enfoque de gestión centrado en las personas y sus derechos, y
basado en los resultados y en el impacto de las acciones que se realizanN
Va Desarrollar una política integral de recursos humanos*en salud*gFC <;>EFM: d@8B:><?; C; 3'L
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*
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:>><@;CK H8CGC;J<G:K <;>EFMC;D@ : E:K H@hE:><@;CK GFE;C8:hECK M BCf@8:8 E: >:E<D:D DC E:K B<KB:KN
.CE J@J:E DC >:K@K ;@J<d<>:D@K DC 3'L C;J8C C;C8@ M :9@KJ@ DC !5562 CE V5s >@88CKH@;DC :E 98FH@
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M ;@ >@;K<DC8: E@K d:>J@8CK DCJC8B<;:;JCK K@><@>FEJF8:ECK2 KCeF:E<D:D M 9l;C8@N W<C;C h:f:
>@hC8JF8: 8CE:J<G: M CK>:K@ d<;:;><:B<C;J@ ;:><@;:EN 0: CKJ8:JC9<: DC H8CGC;><?; CKJT DCJC8B<;:D:
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"hKC8G:><@;CK
La prevención tiene baja prioridad. Los recursos públicos se concentran en la

administración y el tratamiento.
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DCE I@;D@ BF;D<:E2 ;@ Ce<KJ<C;D@ F; H8@98:B: DC H8CGC;><?; :;JCK DC E: <BHECBC;J:><?; DC
lKJ@KN 0:K :>J<G<D:DCK H8CGC;J<G:K K?E@ C8:; CKH@8TD<>:K M ;@ K<KJCBTJ<>:KN
La prevención no está orientada por una estrategia integral, que considere

determinantes sociales, culturales, género y la construcción sociocultural de la
sexualidad.
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@hKC8G: F;: 8CdECe<?; M >:8:>JC8<=:><?; DC d:>J@8CK K@><:ECK M >FEJF8:ECK 8CE:><@;:D@K >@; E:
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D<KCi@ C <BHECBC;J:><?; DC :>><@;CK H8CGC;J<G:KN
Las actividades se concentran en lo concertado con el FM. Intervenciones de pares

excesivamente estructuradas en función de los indicadores del FM.
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32
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Insuficiente participación de las poblaciones clave en el diseño y monitoreo de los

programas de prevención.
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B:M@8X: DC E:K :>J<G<D:DCK CKJT; ><8>F;K>8<HJ:K : E: ><FD:D DC %KF;><?;N
Falta de internalizar la confidencialidad y el enfoque de derechosN
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b@B@d@h<:N
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-KJ@ H@D8X: CeHE<>:82 C; H:8JC2 CE bC>b@ gFC K@h8C CE S5s DC E:K HC8K@;:K >@; 3'L2 lKJC ECK b:M:
K<D@ DCJC>J:D@ C; E: CJ:H: K<D:N
Falta de promoción activa de la prueba de VIH integrada a los servicios de salud. Prueba
y consejería centralizada con escasa disponibilidad. Alta tasas de diagnóstico tardío.
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77
)CE<: )FCEE:8 +8@98:B: DC WFhC8>FE@K<K DCE ,/M4/
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No está sistematizada ni disponible oportunamente una provisión de profilaxis post

exposición.
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D<KH@;<hEC E:K !\ b@8:K C; E:K 9F:8D<:K DC E@K CKJ:hEC><B<C;J@KN
Recomendaciones
1) Rediseño de la estrategia de prevención H:8: F;: 8CKHFCKJ: CdC>J<G: M K@KJC;<hEC CK

F89C;JC F; 8CD<KCi@ DC E: CKJ8:JC9<: DC H8CGC;><?; gFC d@8J:EC=>: M :BHEXC CE J8:h:f@ >@;
+-,%# M E:K H@hE:><@;CK GFE;C8:hECK2 BCf@8C E: Cd<><C;><:2 D<KH@;9: DC 8C>F8K@K
;:><@;:ECK2 :FBC;JC E: >@hC8JF8: DC +W,' M CE :>>CK@ M H8@B@><?; DC F;: @dC8J: 98:JF<J:
DC E: H8FCh: DC 3'L : E: H@hE:><?;N
!a Integrar la oferta de la prueba como un elemento esencial en todos los servicios de
salud. %>JF:EBC;JC CKJ:K :>J<G<D:DCK KC 8C:E<=:; K@E:BC;JC C; E@K >C;J8@K gFC D<KH@;C;
DC /%'K2 M C; CE >:K@ DC 'W/ M DC E: H8CGC;><?; DC E: J8:;KB<K<?; B:JC8;@O<;d:;J<E DCE 3'L
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:k; C; T8C:K ;@ H8<@8<=:D:K H:8: E@K H8@MC>J@K DCE I@;D@ ,F;D<:EN ';>EFK@ C; >C;J8@K
D@;DC dF;><@;:; /%'K KC DCJC>J? E: d:EJ: DC :>>CK@ : E: +W,' M : H8@d<E:e<K H@KJ CeH@K<><?;
C; b@8:8<@ ;@>JF8;@ @ d<;CK DC KCB:;:N
7a Mejorar y profundizar el conocimiento sobre factores determinantes del VIH2 C;J8C CEE@K
E@K K@><@>FEJF8:ECK2 KCeF:E<D:D M 9l;C8@u DC B:;C8: DC :KC;J:8 C; CKC >@;@><B<C;J@ C
<;d@8B:><?;2 E@K H8<;><H<@K2 E:K H@EXJ<>:K M E:K CKJ8:JC9<:K DC H8CGC;><?; :E 3'LN
\a Fortalecer la participación de la sociedad civil en la prevención del VIH M ;@ K?E@ C;
>:E<D:D DC CfC>FJ@8CK DC :>J<G<D:DCK DC H:8CK K<;@ J:Bh<l; >@B@ :>J@8CK DCE D<KCi@ M
CfC>F><?; DC E: H@EXJ<>: M CKJ8:JC9<:K DC H8CGC;><?;N
Ua Prevención secundaria en personas con VIHN .<KCi:8 C <BHECBC;J:8 F;: H@EXJ<>: M
CKJ8:JC9<:K DC H8CGC;><?; KC>F;D:8<: C; HC8K@;:K >@; 3'L2 H:8: CG<J:8 E: J8:;KB<K<?; M E:
8C<;dC>><?; DC CKJ: H@hE:><?;N
Va Evaluar las acciones diseñadas e implementadas DCKJ<;:D:K : :dC>J:8 E: <;><DC;><: DCE
3'LN
Sa Internalizar el enfoque de derechos y de género C; E:K :>J<G<D:DCK DC H8CGC;><?;N
U!
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06 ". )%&')*4*.,"."/& ).(*

N
Resumen -E H:XK >FC;J: >@; F; B@DCE@ DC :JC;><?; <;JC98:E >@;>CHJF:EBC;JC :DC>F:D@7\N 0:

<BHECBC;J:><?; DC CKJC B@DCE@ b: HC8B<J<D@ E@98:8 <BH@8J:;JCK :G:;>CK C; E: H8@G<K<?; DC
KC8G<><@KN -; CE HC8<@D@ DC !55U : !556 <;<><:8@; J8:J:B<C;J@ !NQ75 HC8K@;:KN /<; CBh:89@2 E:
@89:;<=:><?; DC E: :JC;><?; b: K<D@ >@;KJ8F<D: C; d@8B: DCK:8J<>FE:D: M DFHE<>:;D@ KC8G<><@K C; E@K
>C;J8@K DC K:EFD M b@KH<J:ECK `d:8B:><:2 E:h@8:J@8<@2 HK<>@E@9X:2 @J8@KaN 0: d@8B: C; gFC KC
B:JC8<:E<=: E: :JC;><?; ;@ >@;J8<hFMC : C;J8C9:8 F;: H8CKJ:><?; DC >:E<D:D2 DCKd:G@8C>C CE
d@8J:EC><B<C;J@ DC E: 8CKHFCKJ: :E 3'L C; CE KC>J@8 K:EFD2 E<B<J: E: CeH:;K<?; M >@BH8@BCJC E:
K@KJC;<h<E<D:D C; CE E:89@ HE:=@N
Un modelo de atención de la población con VIH y sida fragmentado y desarticulado en

los hospitales y sistemas donde se implementa. No se observa una estrategia clara de
fortalecimiento de los servicios de salud.
-E B@DCE@ DC :JC;><?; <;JC98:E H8@HFCKJ@2 CK C; KX B<KB@ :DC>F:D@ M HC8J<;C;JCN &@ @hKJ:;JC2 E:

@89:;<=:><?; DC E: :JC;><?; b: K<D@ >@;KJ8F<D: C; d@8B: J@J:EBC;JC DCK:8J<>FE:D: : E@K b@KH<J:ECK
C; D@;DC dF;><@;:;2 8CKFEJ:;D@ C; F;: DFHE<>:><?; DC KC8G<><@K `d:8B:><:2 E:h@8:J@8<@2 HK<>@E@9X:2
CJ>Na M B:E: :K<9;:><?; DC E@K 8C>F8K@K M: gFC KC 9C;C8:; >@KJ@K <;;C>CK:8<@KN +:8: CKJ:K
:>J<G<D:DCK KC b: >@;J8:J:D@ 98:; ;kBC8@ DC HC8K@;:E gFC d@8B: H:8JC DC +#"&%/'.% M ;@ DC E:
CKJ8F>JF8: b@KH<J:E:8<:N 0: H@EXJ<>: DC 8C>F8K@K bFB:;@K `>@;J8:J:><?;2 DCK<9;:><?; M KFHC8G<K<?;
DC dF;><@;CKa2 KC EECG: : >:h@ C; d@8B: D<8C>J: DCKDC +#"&%/'.%N 0:K D<dC8C;><:K K:E:8<:ECK
>@;KJ<JFMC; F; CdC>J<G@ DCK<;>C;J<G@ H:8: gFC CE HC8K@;:E gFC ;@ CK H:8JC DC +#"&%/'.% J@BC
:>><?; C; E: :JC;><?; DC H:><C;JCK >@; 3'LN
)@B@ >@;KC>FC;><: KC @hKC8G: F;: d:EJ: DC <;G@EF>8:B<C;J@ M HC8K<KJC;><: DCE CKJ<9B: C; CE 8CKJ@
DCE HC8K@;:E K:;<J:8<@ C; E: :JC;><?; DCE 3'L2 d8C;JC : F;: C;dC8BCD:D gFC ;@ KC v;@8B:J<G<=:p
DCKDC CE ;<GCE >C;J8:EN ">F88C F;: :JC;><?; d8:9BC;J:D: H:8: CE FKF:8<@ M F; DCK:H8@GC>b:B<C;J@
DCE 8C>F8K@ bFB:;@ DC +#"&%/'.%2 CE >F:E :KFBC :>J<G<D:DCK H:8: E:K gFC ;@ b:; K<D@ H8CH:8:D@
`>@B@2 H@8 CfCBHE@2 CE >@;J8@E DC d:8B:><: H@8 H:8JC DC BlD<>@K DCE H8@98:B:au M gFC :h@8D: >@;
D<d<>FEJ:D J:8C:K <;JC98:D:K :E b@KH<J:E `>@B@ KFHC8G<K<?; DC H:><C;JCK 3'L <;JC8;:D@K2 H8@98:B:K
DC H8@d<E:e<K H@KJ CeH@K<><?;2 @J8@K H8@hECB:K <;dC>J@E?9<>@K2 >@@8D<;:><?; >@; @J8@K CKHC><:E<KJ:K
H:8: H8@H@8><@;:8 :JC;><?; : H:><C;JC 3'LaN 0: bCJC8@9C;C<D:D C; E@K J<H@K DC >@;J8:J@ M DC
K:E:8<@K CBHC@8: CKJ: K<JF:><?;N
PRONASIDA ejerce simultáneamente la rectoría en VIH y sida y la atención de las

personas con VIH: superposición de actividades de planificación, vigilancia, monitoreo y
evaluación que lidera el PNS con las actividades de asistencia directa a pacientes.
-E +#"&%/'.% >FC;J: >@; F; >C;J8@ DC :JC;><?; DC HC8K@;:K >@; 3'L M K<D: C; CE B<KB@ CD<d<><@
`/'% C; CE ';KJ<JFJ@ DC ,CD<><;: W8@H<>:E2 ',Wa D@;DC J<C;C KFK @d<><;:K >C;J8:ECKN %J<C;DC CE 6\s
7\
+#"&%/'.%N ,@DCE@ DC :JC;><?; <;JC98:E : E:K +33/ C; CE K<KJCB: HkhE<>@ DC K:EFDN !55R
U7
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DC E@K H:><C;JCK DC +:8:9F:MN -E HC8K@;:E gFC :J<C;DC : E: H@hE:><?; CK CE B<KB@ CgF<H@ Jl>;<>@
DC +#"&%/'.%N -KJC D@hEC 8@E DC +#"&%/'.% M KFK dF;><@;:8<@K `9C;C8:D@8 DC H@EXJ<>:K2 M : E:
B<KB: GC= H8CKJ:D@8 DC KC8G<><@Ka E<B<J: KF >:H:><D:D DC KFHC8G<K:8 E: 8CKHFCKJ: :E 3'L gFC CE
8CKJ@ DCE K<KJCB: DC K:EFD H8@H@8><@;:2 C <BH<DC J8:h:f:8 H:8: d@8J:EC>C8 E@K K<KJCB:K DC K:EFD
CfC8><C;D@ KF 8@E DC 8C>J@8X: KC>J@8<:EN
/C @hKC8G? F;: B:M@8 >@;>C;J8:><?; M d@>:E<=:><?; DC E: :JC;><?; C; CKJC >C;J8@2 E@ gFC :dC>J: E:
<BHECBC;J:><?; DC H8@>CK@K DC DCK>C;J8:E<=:><?; DC E: 8CKHFCKJ: DC E: :JC;><?; C; 3'LN -E
H8@>CK@ DC DCK>C;J8:E<=:><?; b:><: b@KH<J:ECK 8C9<@;:ECK <;<><:D@ b:>C F;@K :i@K ;@ b: K<D@
CdC>J<G@2 M b@M KC E<B<J: : H@>@K H:><C;JCK C; >:D: b@KH<J:E `\6 H:><C;JCK C; J8:J:B<C;J@ C;
)<FD:D DCE -KJC2 QU C; )::9F:=kaN -E B@DCE@ <BHE<>: >@;J8:J:8 F; CgF<H@ >@BHECJ@ C; >:D:
b@KH<J:E2 E@ gFC J<C;C F; :EJ@ >@KJ@ M b: <BHCD<D@ E: CeH:;K<?; :E 8CKJ@ DCE H:XK2 gFCD:;D@ 98:;DCK
=@;:K ;@ >Fh<C8J:K >@B@ CE )b:>@N
Hay una debilidad estratégica del rol rector central en el MSP y BS para la articulación
interprogramática.
-e<KJC F;: <BH@8J:;JC DCh<E<D:D DCE 8@E 8C>J@8 >C;J8:E gFC KC CG<DC;><: H@8 <;KFd<><C;JC J8:h:f@
<;JC8H8@98:BTJ<>@N -KJ@ KC @hKC8G: C; E:K 8CE:><@;CK >@; CE H8@98:B: DC W4 D@;DC K?E@ KC b:
H@D<D@ CKJFD<:8 CE Us DC E@K H:><C;JCK >@; W4 M C; E@K >C;J8@K HC;<JC;><:8<@K2 D@;DC ;@ b:M F;:
8CKHFCKJ: :DC>F:D:N &@ KC HC8><hC E: hkKgFCD: DC >@;KC;K@ H:8: E: DCd<;<><?; DC CKJ8:JC9<:K M
;@8B:KN
Un alto centralismo en la respuesta al VIH y el sida.
-E H8@98:B: CfC8>C F; >C;J8:E<KB@ C; J@D@K KFK ;<GCECK >@; E<B<J:D:K @H@8JF;<D:DCK DC

H:8J<><H:><?;2 <;>EFK@ DC E@K B<KB@K 8CH8CKC;J:;JCK DC +#"&%/'.% DC E@K ;<GCECK 8C9<@;:E M E@>:EN
/C 8CgF<C8C; :FJ@8<=:><@;CK HF;JF:ECK H:8: FJ<E<=:8 H8FCh:K 8TH<D:K C; F; <;D<G<DF@ gFC ;@ KC:
F;: BFfC8 CBh:8:=:D: M b:KJ: H:8: DC><D<8 <;<><:82 KFKHC;DC8 @ B@D<d<>:8 F; CKgFCB: DC H8<BC8:
EX;C:N -KJ@ <BH<DC CE <;G@EF>8:B<C;J@2 E: >:H:><J:><?; HC8B:;C;JC M CE >@BH8@B<K@ DCE 8C>F8K@
bFB:;@N
Un sistema de información ineficiente y sin devolución a los niveles de trabajo.
/C b: <BHECBC;J:D@ F; K<KJCB: >@BHECf@ C <;Cd<><C;JC DC 8C9<KJ8@ DC <;d@8B:><?;2 H8<;><H:EBC;JC

D<KCi:D@ H:8: E:K :>J<G<D:DCK M BCJ:K H8@HFCKJ:K H:8: CE H8@MC>J@ DCE d@;D@ BF;D<:EN -K
<;Cd<><C;JC DCh<D@ : E: ;C>CK<D:D DC EEC;:8 F;: BFEJ<JFD DC H:HCECK M HE:;<EE:K2 gFC >@;KFBC;
BF>b@ J<CBH@ DCE HC8K@;:E : >:89@2 M H@8gFC DCK>F<D: @J8@K :KHC>J@K DC G:E<DC= 8C>@;@><D: >@B@
CE 8C9<KJ8@ K<KJCBTJ<>@ DC :DbC8C;><:2 E: FJ<E<=:><?; DC <;D<>:D@8CK DC :EC8J: JCBH8:;:2 C;J8C @J8@KN
% HCK:8 DC 8C>@EC>J:8 CKJ: <;d@8B:><?;2 ;@ KC HC8><hC gFC E@K ;<GCECK E@>:ECK M 8C9<@;:ECK
H:8J<><HC; C; CE :;TE<K<K @ C; CE HE:;C:B<C;J@ @ D<KCi@ DC :>J<G<D:DCK C <;JC8GC;><@;CK : ;<GCE
E@>:EN &@ b:M H8@>CK@K DC DCG@EF><?; DC E: <;d@8B:><?; : E@K ;<GCECK 8C9<@;:ECK M E@>:ECKN
U\
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Ausencia de estrategias y priorización de la investigación y estudio.
-E H8@98:B: ;@ BFCKJ8: F;: EX;C: >E:8: DC H8<@8<=:><?; DC E:K :>J<G<D:DCK DC <;GCKJ<9:><?; C;

dF;><?; DC E:K ;C>CK<D:DCK DCE H:XK2 M KC E<B<J: : <;JC;J:8 8CKH@;DC8 @ K@EF><@;:8 K<JF:><@;CK
:K@><:D:K : KFK >@BH8@B<K@K >@; CE H8@MC>J@ >@; CE d@;D@ BF;D<:EN
Diagnóstico tardíos, alta mortalidad y dificultades para los estudios de CD4 y CV.
+C8K<KJC; E@K H8@hECB:K DC D<:9;?KJ<>@ J:8DX@ M DC B@8J:E<D:D :EJ:2 >@; F;: ><d8: DC Q\5OQU5
BFC8JCK :;F:ECK H@8 K<D: 8CH@8J:D:KN % ;<GCE E@>:E KC CG<DC;><: F;: 98:; D<d<>FEJ:D DC E@K H:><C;JCK
C; :>>CDC8 : E@K CKJFD<@K DC ).\ @ >:89: G<8:EN ,F>b:K GC>CK KC C;GX:; E@K H:><C;JCK :E ;<GCE
>C;J8:EN 0: E@9XKJ<>: DC J8:;KH@8JC DC BFCKJ8:K CK >@BHE<>:D: DCh<D@ : gFC KC C;GX: K:;98C C;JC8:
M ;@ KC KCH:8: CE HE:KB: : ;<GCE E@>:E È@ gFC H@D8X: 8C:E<=:8KC dT><EBC;JC C; CE E:h@8:J@8<@ DCE
b@KH<J:EaN /C b:; DCJC>J:D@ d:EE:K C; E: E@9XKJ<>: DC H8@G<K<?; M D<KJ8<hF><?; DC BCD<>:BC;J@K C
<;KFB@KN -e<KJC F;: :EJ: J:K: DC d:EJ: DC 8CJC;><?; M B:E: :DbC8C;><: `8CdC8<D: C; F; S5OR5sa M ;@
KC D<KH@;C DC BC>:;<KB@K >@BF;<J:8<@K H:8: d:><E<J:8 E: :DbC8C;><:N
#436E47>;386745
Qa Modificar el rol de PRONASIDA H:8: gFC KC >@;>C;J8C Oh:f@ E: @8<C;J:><?; DCE ,/+ M 4/ >@B@
C;JC 8C>J@8 DCE KC>J@8 K:EFDO C; E: DCd<;<><?; DC H@EXJ<>:K M CKJ8:JC9<:K2 :>J<G<D:DCK ;@8B:J<G:K2
E: HE:;<d<>:><?; M CE >@;J8@E DC >:E<D:D DC E: H8@G<K<?; DC KC8G<><@K M DCfC E: dF;><?; DC
:K<KJC;><: gFC >@88CKH@;DC : E@K KC8G<><@K DC K:EFDN
!a Reorganizar los SAIs H:8: <;<><:8 F; H8@>CK@ DC <;JC98:><?; dF;><@;:E DC E:K :>J<G<D:DCK DC E@K
/%'K C; E@K CKJ:hEC><B<C;J@K DC K:EFD C; gFC @HC8:;N
7a No crear nuevos SAIs con la modalidad organizativa que se da actualmente.
\a Desarrollar una estrategia integrada con los otros programas de salud existentes
`:D@ECK>C;><:2 K:EFD KCeF:E M 8CH8@DF>J<G:2 C;J8C @J8@Ka H:8: gFC HFCD:; KC8 J:Bh<l;
CdC>J@8CK DC :>J<G<D:DCK DC H8@B@><?;2 H8CGC;><?; M D<:9;?KJ<>@ M :JC;><?; DC 3'L2
<DC:EBC;JC C; CE H8<BC8 ;<GCE DC :JC;><?;N -K DC H:8J<>FE:8 8CECG:;><: b:>C8 CdC>J<G@ CE
:>FC8D@ DC >@E:h@8:><?; C;J8C E@K H8@98:B:K DC 3'L M W4) : d<; DC :KC9F8:8 E: @dC8J:
D<:9;@KJ<>: DC 3'L C; E@K H:><C;JCK >@; W4)2 E: H8CGC;><?; DC E: W4) C; H:><C;JCK 3'L2 M
d:><E<J:8 CE J8:J:B<C;J@ :;J<88CJ8@G<8:E @H@8JF;@ C; CKJ@K H:><C;JCK2 DC :>FC8D@ >@; E:
CKJ8:JC9<: 7' DC E: ",/N
Ua Actualizar y optimizar los procesos normativos de las guías terapéuticasN -K <BH8CK><;D<hEC
CKJ:hEC>C8 F; BC>:;<KB@ H:8J<><H:J<G@ gFC :KC9F8C E: HFCKJ: :E DX: C <;>EFK<?; DC E: CG<DC;><:
8C><C;JC : ;<GCE <;JC8;:><@;:E M KF :DC>F:><?; : E: K<JF:><?; ;:><@;:EN -K F89C;JC 8CG<K:8 E:K
9FX:K :>JF:ECK2 gFC D<d<>FEJ:; E: dF;><?; @8<C;J:D@8:N 0: d:EJ: DC >E:8<D:D C; E:K
8C>@BC;D:><@;CK DC J8:J:B<C;J@ DC KC9F;D: EX;C:2 @ E: <;>@8H@8:><?; DC dT8B:>@K ;@
8C9<KJ8:D@K H:8: CE J8:J:B<C;J@ DC <;dC>><@;CK @H@8JF;<KJ:K2 HFCDC; KC8 F;: KC8<: E<B<J:;JC
H:8: E: <;JC98:><?; DC E: :JC;><?;N
UU
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Va D6:B;<434: <; 3;P;38>;> >4 >43858?7 >4 <65 4QH8P65 B:;B;7B45 47 <65 7894<45 :4G867;<45 F
<63;<45M -E :EJ@ 98:D@ DC >C;J8:E<=:><?; DCE H8@>CK@ DC J@B: DC DC><K<@;CK K@h8C>:89: CE ;<GCE
>C;J8:E M E<B<J: E: >:H:><D:D E@>:EN /C 8C>@B<C;D: BCf@8:8 CE H8@>CK@ ;@8B:J<G@2 d@8J:EC>C8 E:K
:>J<G<D:DCK DC C;J8C;:B<C;J@ M DC CDF>:><?; >@;J<;F: H:8: gFC E:K DC><K<@;CK : ;<GCE E@>:E KC
HFCD:; EECG:8 : >:h@ C; d@8B: CdC>J<G: M @H@8JF;:N
Sa Mejorar los niveles de adherencia y la retención de los pacientesN -K ;C>CK:8<@ 8C>@EC>J:8 M
H8@>CK:8 E: <;d@8B:><?; >EX;<>: K@h8C E@K ;<GCECK DC :DbC8C;><:2 >@BH8C;DC8 E@K d:>J@8CK gFC
EECG:; :E :h:;D@;@ M D<KCi:8 <;JC8GC;><@;CK H:8: E@>:E<=:8 M 8CO>:HJ:8 E@K H:><C;JCK2 C;
H:8J<>FE:8 H8@B@G<C;D@ CE <;G@EF>8:B<C;J@ DC E:K :K@><:><@;CK DC H:><C;JCKN %DCBTK2 BCf@8:8
E: HE:;<d<>:><?; M E: E@9XKJ<>: H:8: :KC9F8:8 CE KFB<;<KJ8@ >@;KJ:;JC2 8C>@EC>J:8 M H8@>CK:8 C;
d@8B: K<KJCBTJ<>: E: <;d@8B:><?; DC d:8B:><: M DCBTKN
Ra Considerar integrar el laboratorio de referencia de PRONASIDA en el laboratorio 347B:;<N 0:
>8C:><?; DC F;: KC>><?; DC G<8@E@9X: C; CE E:h@8:J@8<@ ;:><@;:E DC 8CdC8C;><: HC8B<J<8X:
@HJ<B<=:8 8C>F8K@K M :H8@GC>b:8 E:K 8CDCK Ce<KJC;JCK DC DC8<G:><?;N
6a Asegurar el compromiso y la participación de los otros actores en la provisión de serviciosR :
d<; DC :KC9F8:8 :>>CK@ M :E<;C:><?; DC >8<JC8<@K DC <;<><@ M CKgFCB:K DC J8:J:B<C;J@ `C;
H:8J<>FE:8 >@; CE ';KJ<JFJ@ DC +8CG<K<?; /@><:E2 CE KC>J@8 H8<G:D@2 CE K<KJCB: >:8>CE:8<@aN*
Q5a Perfeccionar los procesos de análisis y devolución de la información estratégica de la
atención. -K ;C>CK:8<@ gFC E:K 8C9<@;CK M >C;J8@K DC K:EFD D<KH@;9:; DC E: <;d@8B:><?;
CKJ8:Jl9<>: H8@>CK:D: : H:8J<8 DC KFK D:J@K M 8CH@8JCK2 H:8: :E<BC;J:8 KFK H8@>CK@K DC
HE:;<d<>:><?; M CeHE<>:8 E: JC;DC;><: DC E: C;dC8BCD:D `C; H:8J<>FE:8 E: H8CG:EC;><: C;
H@hE:><@;CK >E:GC M C; B@8J:E<D:D2 >FM: ><d8: KC b: B:;JC;<D@ >@;KJ:;JC C; E@K kEJ<B@K 7 :i@K
C; :H8@e<B:D:BC;JC Q\5 >:K@K :E :i@aN
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6 3 1.&')*0 *"7"1. %&/& ).(*
Resumen: 0: CG:EF:><?; DCE T8C: DC $CKJ<?; DC %h:KJC><B<C;J@ >@;K<DC8? J8CK D<BC;K<@;CKP

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BFCKJ8:; gFC Ce<KJC; @H@8JF;<D:DCK K<9;<d<>:J<G:K H:8: BCf@8:8 E: 9CKJ<?; C; >:D: F;: DC E:K J8CK
T8C:K :;:E<=:D:KN -; CE T8C: DC >@BH8:K2 Ce<KJC F;: @H@8JF;<D:D <;BCD<:J: H:8: BCf@8:8 E:
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1. Análisis de planificación de compras 2009 de PRONASIDA
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Tabla 1: Análisis de posibles reducciones inmediatas en base a planificación de compras 2009 de PRONASIDA
Precio Referencia Precio Referencia

I@8B: ):;J<D:D MS Paraguay (US$) Internacional (US$) Reducciones Posibles
%#3 Nro Veces
I:8B:>CFJ<>: `F;<D:DCKa Precio Precio de Sobre-
Unitario Costo Total Unitario Costo Total precio Total (US$) %
Medicamentos CON posibilidad de reduccion inmediata $ 465,652 $ 90,927 5 $ (374,725) -80%
Lamivudina 10mg/ml jarabe 720 $ 13.00 $ 9,360 $ 2.07 $ 1,490 6 $ (7,870) -84%
Lamivudina 150mg comprimidos 21,600 $ 0.74 $ 15,876 $ 0.05 $ 1,167 14 $ (14,709) -93%
Zidovudina 300 mg/Lamivudina 150 mg comprimidos 36,000 $ 1.41 $ 50,760 $ 0.18 $ 6,624 8 $ (44,136) -87%
Estavudina 30mg capsulas 21,600 $ 0.96 $ 20,801 $ 0.04 $ 869 24 $ (19,931) -96%
Didanosina 400mg comprimidos 25,200 $ 2.84 $ 71,568 $ 0.77 $ 19,330 4 $ (52,238) -73%
Nevirapina 10mg/ml. jarabe 720 $ 110.00 $ 79,200 $ 2.10 $ 1,515 52 $ (77,685) -98%
Nevirapina 200 mg comprimidos 36,000 $ 0.55 $ 19,800 $ 0.06 $ 2,318 9 $ (17,482) -88%
Efavirenz 600mg comprimidos 10,800 $ 8.00 $ 86,399 $ 0.34 $ 3,627 24 $ (82,772) -96%
Lopinavir/ritonavir 200/50mg comprimido 144,000 $ 0.78 $ 111,888 $ 0.37 $ 53,986 2 $ (57,902) -52%
Medicamentos SIN posibilidad de reduccion inmediata $ 232,125 $ 232,125
Ritonavir 100mg comprimido 54,000 $ 1.83 $ 98,658
Lopinavir/ritonavir 80/20 mg jarabe 240 $ 56.11 $ 13,467
Raltegravir 400 mg. comprimidos 3,600 $ 13.33 $ 48,000
Etravirina 100 mg. comprimidos 7,200 $ 5.00 $ 36,000

tabletas
Darunavir 300 mg. recubiertas 7,200 $ 5.00 $ 36,000
TOTAL $ 697,777 $ 323,052 $ (374,725) -54%
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2. Licitaciones realizadas (o en proceso de realización) por el Ministerio de Salud en 2009
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Tabla 2: Análisis de posibles reducciones inmediatas en base a cantidades licitadas por el MSP y BS en 2009
Precios Adjudicados MS Precios Referencial Factor

Paraguay (US$) Internacional (US$) de Reducciones Posibles
ARV Cantidad
Precio Precio Sobre
Unitario Total Unitario Total precio Total (US$) %
Licitacion 65/09 (Ya adjudicada)

Reduccion Inmediata $ 181,836 $ 23,080 8 $ (158,756) -87%
Zidovudina 300/Lamivudina 150 78000 $ 1.34 $ 104,520 $ 0.18 $ 14,352 7 $ (90,168) -86%
Nevirapina 200 78000 $ 0.70 $ 54,600 $ 0.06 $ 5,023 11 $ (49,577) -91%
Estavudina 30 12000 $ 0.92 $ 11,040 $ 0.04 $ 483 23 $ (10,557) -96%
Didanosina 400 4200 $ 2.78 $ 11,676 $ 0.77 $ 3,222 4 $ (8,454) -72%
Sin reduccion inmediata $ 45,864 $ 45,864

Ritonavir 100 21000 $ 2.18 $ 45,864
TOTAL $ 227,700 $ 68,944 $ (158,756) -70%
Licitacion 34/09 (En curso)

Reduccion Inmediata $ 186,992 0 $ 64,861 3 $ (122,131) -65%
Didanosina 400 6245 $ 2.78 $ 17,361 $ 0.77 $ 4,790 4 $ (12,571) -72%
Lopinavir/ritonavir 200/50 149878 $ 0.90 $ 134,590 $ 0.37 $ 56,189 2 $ (78,401) -58%
Estavudina 30 10800 $ 0.92 $ 9,936 $ 0.04 $ 435 23 $ (9,501) -96%
Zidovudina 300/Lamivudina 150 18735 $ 1.34 $ 25,105 $ 0.18 $ 3,447 7 $ (21,658) -86%
Sin reduccion inmediata $ 45,526 $ 45,526

Ritonavir 100 16861 $ 1.83 $ 30,805
Lopinavir/ritonavir 80+20 250 $ 58.88 $ 14,721
TOTAL $ 232,518 $ 110,387 $ (122,131) -53%
TOTAL 2009 (ambas licitaciones) $ 460,218 $ 179,331 $ (280,887) -61%
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Tabla 3: Promedio de incremento de precios de seis ARV en periodo 2005 – 2009:

Precios Paraguay
%
2005 2009 Variacion
&CG<8:H<;: !55 $ 0.57 $ 0.70 23%
/J:GFD<;: 75 $ 0.79 $ 0.92 16%
(<D@GFD<;:^0:B<GFD<;: 755^QU5 $ 0.79 $ 1.34 69%
#<J@;:G<8 Q55 $ 1.10 $ 2.18 98%
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0@H<;:G<8^#<J@;:G<8 !55Û5 $ 3.12 $ 0.90 -71%
0@H<;:G<8^#<J@;:G<8 f:8:hC $ 200.89 $ 58.88 -71%
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CBH8CK:K <;;@G:D@8:K `;@ 9C;l8<>@KaN -K ;C>CK:8<@ :>E:8:8 gFC '.% 9C;C8:EBC;JC :>>CDC :
BCD<>:BC;J@K 9C;l8<>@K `DC bC>b@ b: H@D<D@ b:>C8E@ H:8: @J8@K BCD<>:BC;J@K2 >@B@ :gFCEE@K H:8:
<;dC>><@;CK @H@8JF;<KJ:KaN -KJ@K H8C><@K HFCDC; b@M @HJ<B<=:8KC : J8:GlK DC E: >@BH8: `C; H@8 E@ BC;@K
D@K DC E@K J8CK BCD<>:BC;J@K C; >FCKJ<?;a DC GC8K<@;CK 9C;l8<>:K H8C>:E<d<>:D:K H@8 ",/N % HCK:8 gFC
E@K H8C><@K H:9:D@K ;@ K@; b@M E@K BTK h:f@K2 KC CG<J? H@8 E@ BC;@K C; CK: >@BH8: <;JC8;:><@;:E CE
K@h8CH8C><@ >:89:D@ H@8 E@K <;JC8BCD<:8<@K ;:><@;:ECK C; E:K E<><J:><@;CK HkhE<>:KN
c. Index: CKJ: dFC F;: >@BH8: E@>:E2 HC8@ K<; CdC>J@ Ce:>C8h:D@ C; CE H8C><@ DCE BCD<>:BC;J@2 D:D@ gFC
H:8: CKJC H8@DF>J@ `0@H<;:G<8^8<J@;:G<8 HCD<TJ8<>@a E: CBH8CK: d:h8<>:;JC KFCEC <BH@;C8 CE H8C><@ d<;:E :E
<;JC8BCD<:8<@ E@>:E2 H:8: :KC9F8:8 >@;K<KJC;><: `;FCG:BC;JC2 K?E@ H:8: CKJC BCD<>:BC;J@u ;@ :KX C;
@J8@K BCD<>:BC;J@K @ H8FCh:K DC E:h@8:J@8<@ DC E: B<KB: CBH8CK:a DC H8C><@K C; E@K D<KJ<;J@K H:XKCKN
+:8: E@K D@K BCD<>:BC;J@K gFC J:;J@ )'#. >@B@ CE ,<;<KJC8<@ DC /:EFD HE:;<d<>:8@; >@BH8:8
`0@H<;:G<8^#<J@;:G<8 !55Û52 M -d:G<8C;= V55a2 E@K H8C><@K DC 8CdC8C;><: DCE ,<;<KJC8<@ DC /:EFD dFC8@;
!2U M 75 GC>CK B:M@8CK2 8CKHC>J<G:BC;JC2 gFC E@K DCE )'#. `W:hE: UaN
V7
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
Tabla 4: Comparación de precios CIRD (2009) con precios de referencias internacionales:
Precio Referencia
Compras CIRD (US$) Internacional (US$)
Factor
ARV Presentacion Cantidad
Provee Sobre
Precio FABRICANTE Precio
dor precio
Unitario Total Unitario Total T
Ritonavir/Lopinavir 50/200 mg BTL x 120 comp 1.200 bot OPS Matrix (India)
$ 0.36 $ 51,744 $ 0.37 $ 53,986 1.0 $
Rambaxy
Efavirenz 600 mg BTL x 30 comp 1.217 bot OPS
$ 0.27 $ 9,814 (India) $ 0.34 $ 12,260 0.8 $
Zidovudina jarabe 50 mg/5 ml Frasco x 240 ml 120 frascos OPS CIPLA (India)
$ 2.41 $ 289 $ 2.46 $ 295 1.0 $
Tenofovir 300 mg Caja x 30 comp 365 cajas IDA Gilead

$ 1.29 $ 14,133 $ 0.32 $ 3,463 4.1 $
Tenofovir/ Entricitabina 300/200 mg Caja x 30 comp 1.217 cajas IDA Gilead

$ 1.92 $ 69,997 $ 0.48 $ 17,508 4.0 $
Frasco x 270
Nelfinavir 250 mg 205 frascos IDA Roche Farma
comp $ 0.77 $ 42,790 $ 42,790 $
240 frascos x
Lopinavir/Ritonavir 80/20 mg/ml Kaletra INDEX Abbott
160 ml $ 57.45 $ 13,787 $ 13,787 $
*6B;< " !5!2UU\ " Q\\2565 "
Tabla 5: Comparación precios MSP y BS y CIRD:
CIRD MS Factor
ARV (a traves de (mercado Sobreprecio
OPS) local) MS/CIRD
Ritonavir/Lopinavir
50/200 mg $ 0.36 $ 0.90 2.5
Efavirenz 600 mg
$ 0.27 $ 8.00 30
V\
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
!7S<8585
,;<H>N -; >4CKJ:
36EP:;5 F P:43865
CG:EF:><?; >4 P:H4L;5
KC FK: CE >@;>CHJ@>4 <;L6:;B6:86N
DC K<KJCB: &$c F &;:G;
DC K:EFD .8:;< H@8 E: "89:;<=:><?;
H8@HFCKJ@
a #CKHC>J@ DC
Reducciones <;JC;><?; E@K H8C><@K
H8<B:8<: DC E:K H8FCh:K
CK H8@B@GC82 8C>FHC8:8 DC ):89: 3<8:E ME:).\2
@ B:;JC;C8 E: >@BH:8:><?;
K:EFDN CK BTKE@KD<dX><E
-KJ@ <;>EFMC J:;J@ D:D@
CKdFC8=@K
$)
Factor
Posibles gFC ;@
H:8: K?E@ KC H8@GCC;
<;dEFC;><:8 8C:>J<G@K MDC>@;KFB<hECK2
E@K DCJC8B<;:;JCK K:EFD J:;J@ K<;@>@B@gFC E:K :DCBTK
:>J<G<D:DCKb:M@8<C;J:D:K
gFC >@;K<DC8:8 CE J<H@ DC:
D<8C>J:BC;JC
Sobre >@;J8:J@ DCE
BCf@8:82 CgF<H@
:JC;DC8 `>@B@D:J@ E:
M 8CKJ:hEC>C8 @ >@BH8:a2
K:EFDN 1;Jl8B<;@K
K<KJCB: DC DC B:;JC;<B<C;J@
K:EFD CK2 H@8 E@MJ:;J@2
KC8G<><@2
BTKC;J8C;:B<C;J@2
gFC E: 8CD DC
precio
Total (US$) CJ>N 0:BC;J:hECBC;JC
% CKJ:hEC><B<C;J@K HkhE<>@K gFC C;J8C9:; :JC;><?;N ';>EFMC2 H@8 CfCBHE@2 : E: B:D8C gFC >F<D:H:8:
DF8:;JC E: CG:EF:><?; ;@ KC D<KH@;<h<E<=:8@; E@K >@;J8:J@K 8CKHC>J<G@K DCE
H@DC8 :;:E<=:8E@KN /<; CBh:89@2 C; h:KC : E: <;d@8B:><?; DC H8C><@K @hJC;<D:2
;<i@ C;dC8B@ C; KF b@9:82 H8@GCCD@8CK H8<G:D@K2 H8@98:B:K H:8: E: B@D<d<>:><?; DC >@;DF>J:2 KC HFCDC; b:>C8 E:K
6 1.0 $ 2,242
K<9F<C;JCK
>:BH:i:K @hKC8G:><@;CKP
H:8: CE >@;J8@E DC GC>J@8CK2 C;J<D:DCK :KC9F8:D@8:K2 K:EFD @>FH:><@;:E M F; B:8>@
0 0.8 $ 2,446 fF8XD<>@ CdC>J<G@pNU
:N %E <9F:E gFC H:8: E@K %#3K `:F;gFC C; BC;@8 CK>:E:a2 E@K H8C><@K DC H8FCh:K DC ).\ M ):89:
5 1.0 $ 6
,85B4E;
3<8:E >4
C; ,;<H>P
+:8:9F:M<;>EFMC : J@D:K E:K :@89:;<=:><@;CK2
K@; KFHC8<@8CK E@K DC @J8@K H:XKCK HC8K@;:K
DC E: M8C9<?;
:>><@;CK
gFC>FM:
b:; <;JC;><?;
bC>b@ F;:H8<B:8<:
9CKJ<?;
3 4.1 $ (10,670) -75%CK H8@B@GC82
CKJ8:Jl9<>: DC >@BH8:K `h:K:D: C; @HJ<B<=:><?; DC E: HE:;<d<>:><?; M H8@B@><?; DC E@K
8C>FHC8:8 @ B:;JC;C8 E: K:EFDN -KJ@ <;>EFMC J:;J@ E@K CKdFC8=@K H:8: <;dEFC;><:8 E:
DCJC8B<;:;JCK
>@BHCJC;><:a DC H:8:
K:EFD8CDF><8
J:;J@ >@B@ E:K :>J<G<D:DCK
CdC>J<G:BC;JC @8<C;J:D:K D<8C>J:BC;JC : BCf@8:82 :JC;DC8 M
E@K H8C><@KN
8 4.0 $ (52,488) -75%
0 $ - HkhE<>@K
-; E: W:hE:gFC C;J8C9:;
V KC >@BH:8: :JC;><?;N ';>EFMC2
H8C><@K gFC KC b:;H@8@hKC8G:D@
CfCBHE@2 C; : E:@J8@K
B:D8C gFC DC
H:XKCK >F<D: DCE ;<i@
E: 8C9<?;2 C;dC8B@
J8:K C;
9CKJ<@;CK
KF b@9:82 H8@GCCD@8CK H8<G:D@K2 H8@98:B:K H:8:
DC CKJC J<H@2 >@; E@K :>JF:EBC;JC @hKC8G:D@K C; +:8:9F:MN E: B@D<d<>:><?; DC >@;DF>J:2 >:BH:i:K H:8: CE
7 $ -
5 ';>EFMC
" ÙR2\VUa -29%Tabla 6: :>><@;CK
Comparación<;JC8KC>J@8<:ECK
de precios conDCE HC8K@;:E
otros países deDCAmérica
K:EFD2 H@8 CfCBHE@2 Ceb@8J:;D@ :E ,<;<KJC8<@ DC
Latina:
)@KJ@^ #CdC8C;><:K
V
F;: BCf@8 K:EFDN
H8FCh: >@BHCJ<J<G:K I:>J@8
`1/"a 0:J<;@:Bl8<>: +:8:9F:M /@h8CH8C><@
9:8:;J<=:8
).\ E: H8@DF>><?;2
U : QU CE :;TE<K<K2
!6 E: D<dFK<?; M CE FK@ DC <;d@8B:><?; d<DCD<9;: M @H@8JF;: H:8:
! : V GC>CK
)3
<;d@8B:><?; 75 :8CdC8C;><:
b:>C \5 6\DCJC8B<;:;JCK
: E@K # 7 GC>CK DC E: K:EFD2 CE DCKCBHCi@ DCE K<KJCB: M CE CKJ:D@
hN % HCK:8 DCE :FBC;J@ DCE G@EFBC; DC H8FCh:K 8C:E<=:D:K DF8:;JC E@K kEJ<B@K :i@K2 E@K H8C><@K
KC b:; B:;JC;<D@ @ C; >:K@K :FBC;J:D@N 1; :FBC;J@ DC Q5 GC>CK DCE G@EFBC; DC FK@ DC E:
):89: 3<8:E C; CE KC>J@8 HkhE<>@ dFC :>@BH:i:D@ H@8 F; <;>8CBC;J@ `C; EF9:8 DC F;:
8CDF>><?;a DCE H8C><@ DC QUs `W:hE: SaN 1; :FBC;J@ DC !\ GC>CK DC E: >:;J<D:D DC H8FCh:K DC
).\ >@BH8:D:K 8CKFEJ? C; F;: 8CDF>><?; DC H8C><@ DC K?E@ Vs `W:hE: RaN
Tabla 7: Incremento % de cantidad y precio de C:. Tabla 8: Aumento pruebas CD4 y disminución del
precio de la prueba:
):;J<D:D J@J:E ):;J<D:D J@J:E
&. >@BH8:D: `,/ +8C><@ ,/ &$c >@BH8:D: `,/ +8C><@ ,/
~ )'#.a +:8:9F:M ~ )'#.a +:8:9F:M
!55U U55 R! !55U !55 7Q
!556 \SV\ 6\ !556 \S55 !6

U
D;3B6: D;3B6:
.;:8;38?7 \iZ jiga .;:8;38?7 \Yc _[a
$C;CG: !55S
V qL"N 'h<DN
VU
Q7
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
,I7B4585
W8:K J@D@K CKJ@K
HC8KHC>J<G: :;TE<K<K2 8CKFB<B@K
M DCB:;D: DCE FKF:8<@: DC
>@;J<;F:><?; E: D<;TB<>:
E@K KC8G<><@K2 @hKC8G:D:
>@;fF;J@K DC E@K
<;JC98:D@K DCH8C><@K DC E@K
H8CKJ:><@;CK
<;KFB@K H:8: B:;Cf@
9:8:;J<=:D:K2 J8:J:B<C;J@
DC E:M<;d8:CKJ8F>JF8:
D<:9;?KJ<>@ DC M3'L C; E@K kEJ<B@K :i@K `!55UO!556a C; +:8:9F:MP
E@9XKJ<>:N
!#.5
•H8CKC;J:; >@BH@8J:B<C;J@K
0@K H8C><@K DC E@K %#3K C; gFC+:8:9F:M
:FBC;J:; K@;E::EJXK<B@K
H8@h:h<E<D:D DC CeH@K<><?;
`! : BTK DC U5 GC>CK :E KFHC8<@8CKa2
3'LN -KJ@K
>@BH@8J:B<C;J@K
>@BH:8:D@K >@; <;>EFMC; KCe@ K<; H8@JC>><?;
E:K 8CdC8C;><:K DC H8C><@K`C; H:8J<>FE:8 KCe@
>@BHCJ<J<G@K :;:Ea2 KCe@ >@;
<;JC8;:><@;:ECK2 G:8<:K
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F; 98:;M
CE FK@ DC <;KJ8FBC;J@K >@8J@ HF;=:;JC
;kBC8@ DC H:XKCK DC E: 8C9<?; M: :>>CDCN @ CgF<H@K DC <;MC>><?; gFC HFCD:; CKJ:8 >@;J:B<;:D@K
>@; K:;98C <;dC>J:D:N
• W@B:;D@ -KJ:K H@hE:><@;CK
E:K >:;J<D:DCK <;>EFMC; :H:8:
M H8C><@K CKJ<B:D@K b@Bh8CK gFC J<C;C;
E:K >@BH8:K 8CE:><@;CKDCKCeF:ECK
DCE ,/+M4/ >@;
E@K kEJ<B@K
b@Bh8CK
BCKCK2`L/La2 J8:h:f:D@8CK
E:K 8CDF>><@;CK M J8:h:f:D@8:K
H@K<hECK <;BCD<:J:KKCeF:ECK
KFHC8:;`W/a2 KFK >E<C;JCK M E@K FKF:8<@K DC D8@9:K
CE V5sN
•<;MC>J:hECK
-E )'#. `1.'aN
>@BH8: :E9F;@K DC E@K B<KB@K BCD<>:BC;J@K gFC CE ,<;<KJC8<@2 HC8@ [FJ<E<=:;D@
BC>:;<KB@K DC >@BH8: <;JC8;:><@;:EO E@98: C; >:K@K H8C><@K V5s : 65s <;dC8<@8CKN +:8: @J8@K
H8@DF>J@K2 CE )'#. J<C;C F; H@JC;><:E DC 8CDF>><@;CK :D<><@;:ECK : J8:GlK DC E: >@BH8: DC
9C;l8<>@K H8C>:E<d<>:D@K H@8 ",/2 DC H8C><@K <;dC8<@8CK : E@K gFC C; !556 @hJFG@ DC CBH8CK:K
<;;@G:D@8:KN
• % D<dC8C;><: DC E: JC;DC;><: 8C9<@;:E DC D<KB<;F><?; DC X;D<>CK DC H8C><@K DC %#3K `8CDF>><?;
H8@BCD<@ DC BFfC8CK
`H:8J<>FE:8BC;JC UUs DC :>FC8D@
f?GC;CK M:E:DFEJ:Ka2
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DC J8:;KB<K<?; KCeF:E2
C; F;d@8=:D:K
HC8K@;:K H8@BCD<@ DC QQs
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DC H@EXJ<>: gFC KC >@Bh<;:;
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DCE G@EFBC; DC >@BH8: DC CKJ:K H8FCh:K H:8: FK@ C; CE KC>J@8
HkhE<>@ `Q5 : !\ GC>CK DCKDC !55Ua2 E@K H8C><@K H@8 H8FCh: gFC H:9: CE ,/+M4/ ;@ b:;
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1) Discrepancias entre información de cobertura de donación de ARVs de Brasil
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Tabla 9: Medicamentos donados por Brasil en 2008, y cálculo de cantidad de pacientes que
alcanzan a cubrir por el período de un año:
>@BH@8J:B<C;J@K <;>EFMC; KCe@ K<; H8@JC>><?; `C;Unid/ Consolidado
H:8J<>FE:8 KCe@ :;:Ea2 KCe@ Pacientes-
>@; G:8<:K H:8Cf:K M
Medicamentos
CE FK@ DC <;KJ8FBC;J@KPresentación
>@8J@ HF;=:;JCUnidad Paciente Pacientes-
@ CgF<H@K DC <;MC>><?; gFC HFCD:;por funcion Ad6
CKJ:8 >@;J:B<;:D@K
/Año
>@; K:;98C <;dC>J:D:N -KJ:K H@hE:><@;CK <;>EFMC; : b@Bh8CKAño ARV KCeF:ECK
gFC J<C;C; 8CE:><@;CK equivalentes
>@;
730
Estavudina 30mg.
b@Bh8CK Cápsula
`L/La2 J8:h:f:D@8CK 222,240
M J8:h:f:D@8:K KCeF:ECK `W/a2 KFK 304
>E<C;JCK M E@K FKF:8<@K DC D8@9:K
<;MC>J:hECK `1.'aN
Estavudina Sol. Oral (*) Frascos 148 72 2
Zidovudina 100mg. Cápsula 122,040 730 167 Estavudina o

K6L<;386745 9H<74:;L<45 K@; 98FH@K gFC DCh<D@ : d:>J@8CK h<@E?9<>@K2 :Bh<C;J:ECK @1,829
Zidovudina
Zidovudina Sol. Oral
K@><@>FEJF8:ECK (*) >@;J8@E
J<C;C; Frascos
E<B<J:D@2 @1,200 36 33
;<;9k; >@;J8@E2 H:8: 8CDF><8 E: (Nucleosido
CeH@K<><?; 1):E 3'LN -KJ:K
HC8K@;:K
Zidovudina;@ K<CBH8C CKJT;
Inyectable CeHFCKJ:K :E 8<CK9@2
Frascos/Ampolla 600 HC8@?K< KC D: E:?CeH@K<><?; J<C;C BC;@K H@DC8 H:8:
Zidovudina 300mg. +
<;d@8B:><?;2 Comprimidos
K<; b:h<E<D:DCK
Lamivudina 150mg H:8: ;C9@><:8730E@K Jl8B<;@K
@ H@DC8 965,160 1,322 DC KFK C;>FC;J8@K KCeF:ECK
Lamivudina
Lamivudinad@8=:D:K
HC8K@;:K 150mg. : JC;C8 Comprimidos 730
243,720 @ H8CK<@;:D:K
8CE:><@;CK KCeF:ECK 334
: >@;GC8J<8KC C; KCeF:EBC;JC
(Nucleosido 2) :>J<G:K21,682
:gFCEE:K
LamivudinagFC
Sol. J<C;C;
Oral (*) 8CE:><@;CK
Frascos KCeF:ECK920
h:f@ E: <;dEFC;><:
36 DC26:E>@b@E M D8@9:K2 BFfC8CK H8C
HkhC8CK2 :D@ECK>C;JCK M Comprimidos
Nevirapina 200mg.
:gFCEE:K HC8K@;:K >FM: :>J<G<D:D
944,640 730
KCeF:E CK :dC>J:D:
1,294
H@8 E:Ko >@;D<><@;CK
Nevirapina
:Bh<C;J:ECK2 J:ECK >@B@ <;D<G<DF@K H8<G:D@K DC E<hC8J:D `++0a M B<98:;JCKN Indinavir (No 1,590
Indinavir 400mg. Cápsula 432,000 1,460 296 Nucleosido o IP)
(*) Para calcular numero de pacientes cubiertos por presentaciones pediatricas se asumio: a) dosis anual necesaria para
un niño de 10kg, y b) el caso mas conservador, de tamano de frascos de 100ml
2) Discrepancias
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DCK:88@EE@ )'#. `JC;<C;D@ J@D:K E:K H8FCh:K
@89:;<=:><@;:ECK2 CE B<KB@ DCKJ<;@ DC J8:J:B<C;J@ M D<:9;?KJ<>@
C;J8C @J8@K
HkhE<>@ DCE 3'L M CE K<D:aN 0:K >:;J<D:DCK >@BH8:D:K 8CKFEJ:; !2\ : !2R GC>CK B:M@8CK gFC E:
#43H:565 FJ<E<=:D:N
>:;J<D:D OHE;765N %F;-E :HC8K@;:E
K:h<C;D:KK:;<J:8<@
DC gFC E: J8:h:f: M 8CKH@;DC
>:;J<D:D DC B:;C8:
d<;:E FJ<E<=:D: KC8T F; fFKJ: M Cd<><C;JC
H@>@ B:M@8 D:D@H:8:
gFC
E@98:8 E@K BCf@8CK 8CKFEJ:D@K H@K<hECK DC K:EFD2 >@; E@K 8C>F8K@K D<KH@;<hECK M
b:h8T gFC :98C9:8 CE >@;KFB@ E@K kEJ<B@K \ BCKCK `KCHJ<CBh8C : D<><CBh8C DC !556a DCE HC8<@D@C; ><8>F;KJ:;><:K
H:8J<>FE:8CKN
DC !\ BCKCK 0: C;dFC8=: DC `!55RO!556a2
>FCKJ<?; J8:h:f@ C; K:EFD DC F; H:XK
E: D<dC8C;><: >@;KJ:
C;J8C DC E@K H8@GCCD@8CK
E@ >@BH8:D@ DC KC8G<><@K
M E@ FJ<E<=:D@ DC
CK :k; J:;
K:EFD2
98:;DCE@K
gFC9CKJ@8CK
:BC8<J:M8CG<K:8
E@K J8:h:f:D@8CK DC :H@M@N
E@K H:8TBCJ8@K ';>EFMC J:;J@
DC >F:;J<d<>:><?; DC CE KC>J@8 H8<G:D@ >@B@ CE HC8K@;:E
>@BH8:KN
H8@dCK<@;:ECKN
S\
Q!
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
Tabla 10:DC
,F;D<:E Cantidad
E: /:EFDde`",/a2
pruebas CD4 v<;>EFMC
CE >F:E utilizadas: vs. compradas:
J@D:K E:K @89:;<=:><@;CK2 HC8K@;:K M :>><@;CK >FM:
H:8: <;dEFC;><:8 E@K DCJC8B<;:;JCK DCCompradas/
K:EFD J:;J@ >@B@ E:K :>J<G<D:DCK @8<C;J:D:K D<8C>J:BC;JC :
Utilizadas
BCf@8:82 :JC;DC8 Compradas
M 8CKJ:hEC>C8 Utilizadas
E: K:EFDN 1; K<KJCB: DC K:EFD CK2 H@8 E@ J:;J@2 BTK gFC E: 8CD DC
CD4 3350 9240 2.8
>:BH:i:K
Carga ViralH:8: CE 3667
>@;J8@E DC 8742
GC>J@8CK2 C;J<D:DCK
2.4 :KC9F8:D@8:K2 K:EFD @>FH:><@;:E M F; B:8>@
U
fF8XD<>@ CdC>J<G@pN
3) Discrepancias
CK H8@B@GC82 entre@ necesidad
8C>FHC8:8 B:;JC;C8 E:teórica
K:EFDN de-KJ@reactivos de laboratorio
<;>EFMC J:;J@ y utilización
E@K CKdFC8=@K H:8: <;dEFC;><:8 E@K
8CKJ:hEC>C8
.C :>FC8D@ E:
: E:K:EFDN 1; DC
>:;J<D:D K<KJCB: DC K:EFD
H:><C;JCK CK2 H@8
C; W%#3 E@ J:;J@2 BTK gFC
`:H8@e<B:D:BC;JC E: 8CD
!NQ55 DC CKJ:hEC><B<C;J@K
: ;@G<CBh8C DC !556a M
HkhE<>@K gFC C;J8C9:;
C; KC9F<B<C;J@ :JC;><?;N
HC8@ K<; ';>EFMC2
W%#3 `QN555 : H@8 CfCBHE@2
!N5552 KC9k; :CKJ<B:><?;
E: B:D8C gFC >F<D: DCE GC8h:EBC;JC
>@BH:8J<D: ;<i@ C;dC8B@H@8C;
KF b@9:82 H8@GCCD@8CK H8<G:D@K2 H8@98:B:K H:8: E: B@D<d<>:><?; DC >@;DF>J:2
+#"&%/'.%a2 M J@B:;D@ C; >FC;J: E: 8C>@BC;D:><?; DC E:K &@8B:K &:><@;:ECK DC W8:J:B<C;J@ >:BH:i:K H:8: CE
%;J<88CJ8@G<8:E C;J<D:DCK
!556O!5Q5 `! : 7 :KC9F8:D@8:K2
H8FCh:K DC )3K:EFD M ).\@>FH:><@;:E
H@8 :i@ H:8:M H:><C;JCK
F; B:8>@C; fF8XD<>@
W%#32 CdC>J<G@N
M ! H:8:
H:><C;JCK C; KC9F<B<C;J@ K<; W%#3a2 E: K<9F<C;JC E: W:hE: QQ CKJ<B: CE 8:;9@ DC >:;J<D:D DC
';>EFMC :>><@;CK <;JC8KC>J@8<:ECK DCE HC8K@;:E DC K:EFD2 H@8 CfCBHE@2 Ceb@8J:;D@ :E ,<;<KJC8<@
-DF>:><?;
H8FCh:K gFC: DChC8X:;
H8@B@GC8CKHC8:8KC
E: CDF>:><?; DC E:K
8C:E<=:8 BFfC8CK2
C; !556 7S
P E@ gFC >@;KJ<JFMC F; >E:8@ DCJC8B<;:;JC DC
V
F;: BCf@8 K:EFDN
Tabla 11: Cantidad de pruebas CD4 y CV estimadas a realizar en 2009:
9:8:;J<=:8 E: H8@DF>><?;2 CE Media
:;TE<K<K2 E: D<dFK<?; M CE FK@Total
Pruebas/pac Pruebas
DC <;d@8B:><?; d<DCD<9;: M @H@8JF;: H:8:
2009
por ai@ 2009
Pacientes enb:>C
<;d@8B:><?; TARV8CdC8C;><: : E@K 1900DCJC8B<;:;JCK2 a 3DC E: K:EFD2
3800 CE
a 5700
DCKCBHCi@ DCE K<KJCB: M CE CKJ:D@
DC K:EFD DCenE:seguimiento
Pacientes H@hE:><?;N
1000-2000 2 2000 a 4000
(pero sin TARV)
Total 5800 a 9700
/<; CBh:89@2 DC :>FC8D@ : <;d@8B:><?; H8CKC;J:D: H@8 +#"&%/'.%2 E:K H8FCh:K 8C:E<=:D:K :
:9@KJ@ DC !556 b:; K<D@P
).\P QQR7
)3P Q76!
/< :fFKJ:B@K E: H8@MC>><?; JC?8<>: DCE >F:D8@ :;JC8<@8 H:8: >:E>FE:8 CE ;kBC8@ DC H8FCh:K
;C>CK:8<:K DC C;C8@ : :9@KJ@ !556 `J@B:;D@ C; >FC;J: J:Bh<l; gFC E: BCD<: DC H:><C;JCK C;
W%#3 KC8T BC;@8 C; CKC HC8<@D@2 CKJ<B:;D@ F;: BCD<: BX;<B: DC QNSU5 H:><C;JCKa2 E:K
>:;J<D:DCK JC?8<>:K ;C>CK:8<:K H:8: CKC HC8X@D@ 8CKFEJ:; DC 7NS55 : UN!55N
U
37
-KJ:K!55S
$C;CG: K@; >:;J<D:DCK BX;<B:K ;C>CK:8<:K2 D:D@ gFC ;@ CKJ:B@K J@B:;D@ C; >FC;J: @J8@K FK@K H@K<hECK J:ECK >@B@
H8FCh:K
V qL"N DC ):89: 3<8:E ;C>CK:8<:K H:8: D<:9;?KJ<>@ DC ;<i@K CeHFCKJ@K `;:><D@K DC B:D8CK <;dC>J:D:Ka2 C;J8C @J8@K
'h<DN
SU
Q7
!"#$"%&')*+","* #*-(,."# %&/& ).(*0 *#"*, 1+$ 1."*0 #*1&1. /"*0 *1"#$0*"#*!&2* )*+","3$"4*
+@8 E@ >F:E2
:JC;><?; : E:KE:K;C>CK<D:DCK
H8FCh:K CdC>J<G:BC;JC 8C:E<=:D:K
DC K:EFD2 : J8:GlK 8CKFEJ:; Fh<>:><@;CK
DC D<dC8C;JCK K@E@ F;: HCgFCi:
M >@; CEd8:>><?; DC DCE
J8:;K>F8K@ E:K
JC?8<>:BC;JC ;C>CK:8<:KP
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9:8:;J<=:D:K2 7S55OU!55 !7O7!s
DC E: <;d8:CKJ8F>JF8: M E@9XKJ<>:N
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H8CKC;J:;
)@;>EFK<?;P >@BH@8J:B<C;J@K gFC :FBC;J:;
GCB@K F;: 98:; D<dC8C;><: C;J8C E: E: H8@h:h<E<D:D
;C>CK<D:D JC?8<>: DC CeH@K<><?;
DC H8FCh:K :E 3'LN
DC ).\ M )3 -KJ@K
M E:K
>@BH@8J:B<C;J@K <;>EFMC;
H8FCh:K CdC>J<G:BC;JC KCe@ K<;-KJ@
8C:E<=:D:KN H8@JC>><?; `C; ;@
<;D<>: gFC H:8J<>FE:8
KC D: C;KCe@ :;:Ea2 KCe@
E: 8C:E<D:D >@; G:8<:K
CE :>>CK@ : E:KH:8Cf:K
H8FCh:KM
CE FK@ DChC8X:
>@B@ DC <;KJ8FBC;J@K
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DC <;MC>><?;
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CK E:>@;J:B<;:D@K
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DC D<KH@;<h<E<D:D DC 8C:>J<G@K `;@ H:8C>C KC8 CE >:K@a
• +8@hECB:K >@; E@K CgF<H@K `HFCDC >@;J8<hF<8 :E H8@hECB:2 D:D@ gFC KC b: >@;d<8B:D@
<;JC88FH><?; DCE KC8G<><@ DC H8FCh:K H@8 <;D<KH@;<h<E<D:D @ B:E dF;><@;:B<C;J@ DC E@K
CgF<H@Ka
• 0<B<J:D: D<KH@;<h<E<D:D DC K<KJCB: DC J8:;KH@8JC E@9XKJ<>@ DC BFCKJ8:K `H:8C>C J:Bh<l;
Ce<KJ<8 CKJC H8@hECB:2 D:D: gFC :E9F;@K DC E@K /%'K G<K<J:D@K 8C>@;@>C; gFC CKJ: E@9XKJ<>:
DC C;GX@ DC BFCKJ8:K ;@ CKJT >@BHECJ:BC;JC D<KH@;<hECaN 0: :EJC8;:J<G: [gFC CE H:><C;JC
:>FD: :E E:h@8:J@8<@ >C;J8:EO 8CKFEJ: <;:>>CK<hEC H:8: BF>b@K H:><C;JCK D:D@ CE >@KJ@ DCE
J8:;KH@8JC M E: ;C>CK<D:D DC :FKC;J:8KC DCE J8:h:f@N
• I:EJ: DC :DbC8C;><: DC E@K BlD<>@K : E:K 8C>@BC;D:><@;CK2 8CKFEJ:;D@ C; E: ;@
H8CK>8<H><?; DC E: H8FCh: >@; E: d8C>FC;><: ;C>CK:8<: `CKJ@ :HF;J:8X: : F; H8@hECB: DC
>:H:><J:><?; @ DC <;>C;J<G@KaN
4) Necesidad
DC H@EXJ<>: gFCdeKCcapacitación
>@Bh<;:; en >@;gestión de insumos
KFHC8G<K<?; para d@8B:><?;
CdC>J<G:2 atención integral del VIH y 8C9FE:><?;2
DC >@:E<><@;CK2 el sida a la
Dirección
:JC;><?; de Gestión
:E D<KCi@ de Insumos
DCE K<KJCB: Estratégicos
M 8C;D<><?; DC >FC;J:KN
#43H:565N )@;>CHJ@
0: CeHC8<C;><: gFC >@;K<DC8:
C; 9CKJ<?; :E >@;fF;J@
DC CKJ@K <;KFB@K `gFCDC E@K 8C>F8K@K
<;>EFMC ;C>CK:8<@K
HE:;<d<>:><?;2 C; F;: @89:;<=:><?;
>F:;J<d<>:><?;2 H8@MC>><?; @M
<;KJ<JF><?;2
>@BH8:2 C;J8C @J8@Ka 8CK<DC H8<;><H:EBC;JC C; CE +#"&%/'.%N -; dF;><?; DC E: B<K<?;JC>;@E?9<>@2
>@B@ KC8 8C>F8K@K bFB:;@2 8C>F8K@K C>@;?B<>@K M d<;:;><C8@K2 8C>F8K@K DC 9CKJ<?;
BlJ@D@K
CKJ8:Jl9<>:M `;@
BCJ@D@E@9X:K M DC
K?E@ >@BH8:a >@;@><B<C;J@K2
<;KFB@K DC E:8C>F8K@K
.<8C>><?;>@;>CHJF:ECK2
DC $CKJ<?; DC>:H<J:E
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-KJ8:Jl9<>@K DCE
,<;<KJC8<@ DC /:EFD2 E: D<8C>J@8: DC J:E .<8C>><?; b: CeH8CK:D@ E: ;C>CK<D:D DC @hJC;C8
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HC8K@;:E DC CKJ@K
K:;<J:8<@ J8:h:f:<;KFB@K CKHC>Xd<>@K2
M 8CKH@;DC DC B:;C8:gFC fFKJ:
J<C;C;M >:8:>JC8XKJ<>:K
Cd<><C;JC H:8:
H:8J<>FE:8CK C; :KHC>J@K DC >F:;J<d<>:><?;2 @dC8J:^BC8>:D@2 >:E<D:D2 CJ>N -KJ: >:H:><J:><?;
E@98:8 E@K BCf@8CK 8CKFEJ:D@K H@K<hECK DC K:EFD2 >@; E@K 8C>F8K@K D<KH@;<hECK M C; ><8>F;KJ:;><:K KC GC
>@B@ dF;D:BC;J:E
H:8J<>FE:8CKN 0: dFC8=:K< DC
KC J8:h:f@
CKHC8: C; gFC J:E DC
K:EFD F;<D:D HFCD:
F; H:XK >@;KJ:>FBHE<8
DC E@K CdC>J<G:BC;JC
H8@GCCD@8CK DCE:KC8G<><@K
B<K<?; DCDC
8CDF>><?; DC H8C><@K `C;J8C @J8:Ka H:8: E: >F:E dFC <;KJ<JF<D:N
5) Limitada práctica de proyección y evaluación de implicaciones a largo plazo (sobre necesidad
H8@dCK<@;:ECKN
de recursos) en la adopción de normas terapéuticas o políticas
.F8:;JC HC8X@D@ :EDCB<KB@
H@8 E: CH<DCB<:u E: CG:EF:><?;2
J<CBH@ gFC <DC;J<d<>:B@K H@8 E@ BC;@KC;J8CK
KC J8:h:f: <;JC;K:BC;JC 8CDF><8 E: J8:;KB<K<?;
DC><K<@;CK DCE C;
8C:E<=:D:K G<8FK
CE
C;J8C
kEJ<B@E:K H@hE:><@;CK
:i@2 C; B:M@8 8<CK9@
DC 98:; <BH@8J:;><:2 G:E@8M Mb:><: E: H@hE:><?;
;C>CK<D:D DCKDC 9C;C8:EN
CE H8<@8<J:8<@ HF;J@ DC @d8C>C8 :>>CK@ :
BCD<>:BC;J@K M KC8G<><@K ;C>CK:8<@K H:8: E:K +33/2 HC8@ gFC ;@ dFC8@; :>@BH:i:D:K H@8 CE
SV
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;C>CK:8<@ :;TE<K<K
,;<H>N -; CKJ: DC 8C>F8K@K
CG:EF:><?; KC FK:d<;:;><C8@K
CE >@;>CHJ@gFC KC DChC;
DC K<KJCB: <DC;J<d<>:8
DC K:EFD M :KC9F8:8
H8@HFCKJ@ C; E@K :i@K
H@8 E: "89:;<=:><?;
K<9F<C;JCK
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REFERENCIAS
,F;D<:E DC BIBLIOGRÁFICAS
E: /:EFD `",/a2 Y DOCUMENTARIA
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Evaluación para el

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i) CONOCIMIENTO Y VIGILANCIA DE LA EPIDEMIA

:a Mejorar los sistemas de vigilancia epidemiológica DC :>FC8D@ >@; E@K :G:;>CK

ii) RECTORÍA Y GOBERNANZA

kh Reponer la total responsabilidad de la rectoría en materia de la respuesta al VIH y el sida

lh Apoyar el proceso de reglamentación de la recientemente promulgada Ley que establece

:N %KC9F8:8 E: 8C>J@8X: DCE ,<;<KJC8<@ DC /:EFD M 4<C;CKJ:8 /@><:E C; CE H8@>CK@ DC

nh Avanzar en la separación de los roles normativos y de asistencia en PRONASIDAN -KJ@

kh Rediseño de la estrategia de prevención H:8: F;: 8CKHFCKJ: CdC>J<G: M K@KJC;<hEC CK

iv) Atención y tratamiento

-E H:XK >FC;J: >@; F; B@DCE@ DC :JC;><?; <;JC98:E >@;>CHJF:EBC;JC :DC>F:D@N 0: <BHECBC;J:><?;

oh Actualizar y optimizar los procesos normativos de las guías terapéuticasN -K <BH8CK><;D<hEC

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Sistema de Salud y sus componentes

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