Ending AIDS: what will it take?

Report
Ending AIDS: what will it take?
What are the costs?
What’s new and what’s the opportunity?
What should we say about it?
Political Declaration on HIV/AIDS 2011:
resources for the HIV response
• Close the global resource gap by 2015
– $8 billion annually, overall target $24 billion
• Support and strengthen existing financial mechanisms
– including the Global Fund and relevant UN organizations
• Programmes must become more cost-effective and evidencebased and deliver better value for money
• Break the upward trajectory of costs through the efficient
utilization of resources
– Simplify treatment regimens and delivery (Treatment 2.0)
– Integrate HIV programmes with other areas of the health system
• Expand voluntary and additional innovative financing
mechanisms
Global HIV Funding Needs
(based on current HIV clinical eligibility criteria)
Funding for HIV in low- and
middle-income countries, 2002–2011
Global HIV Investment Needs: $24b annually by 2015
US$ billion
Previous projections
UNAIDS Investment
Framework
Business as usual
Donor and National Investments in HIV Prevention among
Key Populations
Source: Global AIDS Response Progress Reporting country reports (most recent available).
Spending smarter and more strategically
Investment categories: High-level, directional guidance
Target HIV investments to:
• Ensure bulk of funding is spent on basic programs.
• Invest in social and programmatic ‘Critical Enablers’ to
ensure robust and sustainable response.
• Invest in HIV-related interventions that support
development goals.
100%
Program areas: Specific benchmarks
tied to different epidemics
90%
80%
BC
70%
60%
KP
50%
Condoms
40%
MC
30%
PMTCT
20%
ART
10%
A
B
0%
C
C
Evidence-based interventions
that target the source of new
infections and effectively
reduce morbidity and
mortality.
What are the opportunities?
A real pivot point: ending the AIDS crisis through
accelerated scale up of treatment, combination
prevention
Halting disease progression—people living successfully with HIV and accelerated
declines in HIV incidence
Quality disease control programs (decentralized, community owned, better
linkage, better adherence) delivering less toxic, more durable, easier to take regimens
Massive scale up of combination HIV prevention
Leveraging dramatic prevention benefits of ART—including with earlier treatment
initiation
Improved vertical transmission prevention regimens (Option B/B+)
Scaled up HIV counseling & testing
Policies, laws and programs that defend, protect and promote human rights of
people with HIV and those at greatest risk of infection
Condoms
Safe medical male circumcision
Clean injecting equipment, oral substitution therapy
Virtually no children born with HIV infection
2011 Political Declaration: key targets for 2015
Reduce sexual transmission by 50%
Reduce transmission of HIV among people who inject drugs by
50%
Eliminate mother-to-child transmission and substantially
reduce AIDS-related maternal deaths
15 million people living with HIV on antiretroviral treatment
Reach a significant level of annual global expenditure (between
$22-$24bn) in LMICs
Scale
UpDeclaration:
Trajectory
for Antiretroviral
2011
Political
key targets
for 2015
Treatment
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Target 6.B:
Achieve, by 2010, universal access to treatment for HIV/AIDS
for all those who need it
35
30
21
10
10
Ending the AIDS crisis through accelerated scale up of
treatment, combination prevention
With acceleration,
Zambia would be able
to avert a total of over
126,000 HIV infections
2012-2016, compared
to baseline.
Combination prevention +
earlier access to tx would
avert 179,200 new HIV
infections—a 57 percent
decline in incidence—over
a four-year period, with
118,000 additional deaths
averted.
Source: PEPFAR Blueprint for an AIDS Free Generation, December 2012
Ending the AIDS crisis through accelerated scale up of
treatment, combination prevention
Through scale up at CD4<350
Kenya could avert 222,600 new
HIV infections and 159,900 by
2016 compared to baseline
Through scale up at CD4<550,
333,300 new HIV infections and
258,000 AIDS-related deaths could be
stopped by 2016
Source: PEPFAR Blueprint for an AIDS Free Generation, December 2012
Spending more now expands coverage and reduces
costs in the near term
Source: PEPFAR Blueprint for an AIDS Free Generation, December 2012
Important developments coming…
The denominator of people with HIV eligible for treatment will
change (launch of WHO 2013 consolidated ART guidelines at
2013 IAS meeting in Kuala Lumpur)
Recommendations on strengthening ART monitoring
(introduction of viral load)
These changes have consequences for global need numbers,
national plans, and Global Fund resource requirements
Advocacy messages: for discussion
We can defeat these epidemics—through massive scale up of
life saving services, building on extraordinary momentum
The “tipping point” in the fight against AIDS is here: we cannot
afford the consequences of slowing down
AIDS is far from over but we know what we need to do to end
it and have the tools
We must aggressively confront the barriers that obstruct
access to services—including discriminatory laws, deadly
inequities, failing health systems, and community responses
that are starved for funding
Shared responsibility and global solidarity for the AIDS
response are essential

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