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FUNDING SLOWDOWN. if : 1. But we can do better. We have done a lot…. Scale up to date guided by a “commodity approach” Unsystematic prioritisation and investment with limited basis in country epidemiology and context Resources spread thinly across many parallel interventions

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  1. FUNDING SLOWDOWN if : 1

  2. But we can do better We have done a lot… Scale up to date guided by a “commodity approach” • Unsystematic prioritisation and investment with limited basis in country epidemiology and context • Resources spread thinly across many parallel interventions • Focus on discrete interventions rather than overall results leading to a fragmented response • Unprecedented scale up of HIV prevention, treatment, care and support • Decline in rate of new HIV infections in many countries • More than 6.6 million people on ART • Millions of orphans receiving basic education, health, social protection BUILDS ON PAST, BUT DOES BETTER if : 2

  3. IF : 3 AIDS Investment Framework CRITICAL ENABLERS BASIC PROGRAMME ACTIVITIES OBJECTIVES Programmes for keypopulations PMTCT • Social enablers • Laws & policies • Community mobilization • Stigma reduction Stopping new infections Behaviour change Condoms • Programme enablers • Community-centered design & delivery • Management & incentives • Production & distribution • Research & innovation Keeping people alive Care & treatment Male circumcision SYNERGIES WITH DEVELOPMENT SECTORS Social protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence; Health systems (incl. treatment of STIs, blood safety); Community systems; Employment practices.

  4. Social enablers • Political commitment & advocacy • Laws, policies & practices • Community mobilization • Stigma reduction • Mass media • Local responses, to change risk environment • Local responses, to change risk environment • Programme enablers • Community-centered design & delivery • Programme communication • Management & incentives • Production & distribution • Research & innovation

  5. THE RETURN ON INVESTMENT iF : 4

  6. Investment framework projections for new HIV infections Optimized investment will lead to rapid declines in new HIV infections in many countries

  7. ALLOCATIVE EFFICIENCY iF: 5

  8. SHARED RESPONSIBILITY iF : 6

  9. 100% 100% 90% 90% 80% 80% 70% 70% 60% 60% Coverage Coverage 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% >500 >500 350-499 350-499 250-349 250-349 200-249 200-249 100-199 100-199 50-99 50-99 <50 <50 CD4 Count (cells/ml) CD4 Count (cells/ml) ART coverage in 2015 by CD4 count CD4 350 15 million 13.1 million (health) T4P

  10. Cost per patient per year (weighted average in US$) 2010 2015 2020 Lab (new patients) 180 129 79 Lab (cont patients) 180 128 76 Service delivery 176 144 112 1st Line ARVs 155 147 57 2nd Line ARVs 1678 984 295

  11. Critical enablers and development synergies: • are necessary but not sufficient by themselves for effective AIDS responses, by supporting basic programme activities • encourage sustainability of AIDS responses through integration into other non-health sectors • are determined and prioritized by country contexts, • require mechanisms for multi-sectoral financing and governance

  12. Development synergies Synergies and enablers – distinct, but overlapping HIV-sensitive (HIV outcome is one of many objectives) HIV-specific (sole/primary objective is an HIV outcome) Critical enablers

  13. Community Mobilization • Little information on cost • Country reviews (USD 1 to 14 per adult population) • Community Health Workers (@ USD 2 per adult population)

  14. Community mobilization assumptions in the investment framework Cost envelope: community mobilisation component of the critical enablers 2011 $0.3bn 2015 $0.6 bn 2020 $1.0 bn Assumptions: Increased community capacity increased community service delivery need for remuneration of community and lay workers need for training, guidance, supervision participation of people living with HIV

  15. Community mobilization: makes scale up possible Number of people tested through community mobilization 2010: 46 million (VCT) 2015: 109 million Service delivery costs (treatment) 2010: $179 per year 2020: $125 per year ($17 in low income countries) Driving costs down: fewer outpatient visits, community support service modalities Better Health Outcomes

  16. Community mobilization: increases effectiveness • Community mobilisation increased HIV testing rates four-fold in Tanzania, Zimbabwe, South Africa and Thailand. • Consistent condom use in past 12 months 4 times higher in communities with good community engagement (Kenya) • Hypothetical circumcision model KwaZulu-Natal : • core intervention: 240,000 infections averted over ten years • with enablers: 420,000 infections averted, with modest marginal increase in costs

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