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A new Investment Framework for the Response to AIDS

A new Investment Framework for the Response to AIDS More Value for the Money within a Framework of Shared Responsibility. Resources available for HIV in low and middle income countries, 1986-2010. We have done a lot…. Unprecedented scale up of HIV prevention, treatment, care and support

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A new Investment Framework for the Response to AIDS

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  1. A new Investment Framework for the Response to AIDS More Value for the Money within a Framework of Shared Responsibility

  2. Resources available for HIV in low and middle income countries, 1986-2010

  3. We have done a lot… • 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

  4. But we can do better 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

  5. New Investment Framework CRITICAL ENABLERS BASIC PROGRAMME ACTIVITIES OBJECTIVES Keypopulations Children & mothers • Social enablers • Political commitment & advocacy • Laws, policies & practices • Community mobilization • Stigma reduction • Mass media • Local responses, to change risk environment Stopping new infections Behaviour change Condoms Keeping people alive • Programme enablers • Community-centered design & delivery • Programme communication • Management & incentives • Production & distribution • Research & innovation 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; Employer practices.

  6. - 2.5 - 2.0 - 1.5 - 1.0 - 0.5 - 0 - 2.5 - 2.0 - 1.5 - 1.0 - 0.5 - 0 New HIV Infections (millions) Three investment scenariosImpact on the epidemic USD (Billions) Business as usual New HIV Infections (millions)

  7. - 2.5 - 2.0 - 1.5 - 1.0 - 0.5 - 0 New HIV Infections (millions) Three investment scenariosImpact on the epidemic Investment framework USD (Billions) Business as usual

  8. - 2.5 - 2.0 - 1.5 - 1.0 - 0.5 - 0 New HIV Infections (millions) Three investment scenariosImpact on the epidemic Rapid scale up previous projections Investment framework USD (Billions) Business as usual

  9. The new investment frameworkFocus on what makes a difference USD (Billions) Synergies Critical Enablers Basic Programme Activities

  10. 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

  11. Returns on investment of new investment framework (2011-2020)

  12. New investment framework: the tipping point Newly eligible for treatment Newly infected

  13. New infections, behaviour change and treatment coverage in Botswana Behaviour change New infections and treatment coverage

  14. Cost and economic returns 2011 to 2020

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

  16. 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

  17. 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

  18. 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

  19. Investement framework allocation in 2015

  20. Resources available for HIV in low and middle income countries, globally, 2002-2010

  21. Percentage of care and treatment expenditure from international sources

  22. Few donors meet the development assistance targets Norway 1.10% Luxembourg 1.09% Sweden 0.97% Denmark 0.90% Netherlands 0.81% Belgium 0.64% United Kingdom 0.56% Finland 0.55% Ireland 0.53% France 0.50% Spain 0.43% Net development assistance in 2001 as % of gross national income Switzerland 0.41% Germany 0.38% Canada 0.33% Austria 0.32% Australia 0.32% Portugal 0.29% New Zealand 0.26% United States 0.21% Japan 0.20% Greece 0.17% Italy 0.15% Korea 0.12% 0% 0.3% 0.5% 0.7% 1% 1.2%

  23. Measuring national commitment to AIDS: the Domestic Investment Priority Index SOURCE: UNAIDS expenditure data; WHO data on the burden disease; and economic data from the International Monetary Fund World Economic Outlook database

  24. Economic growth in Africa, 1970–2010 Third-fastest growing region in the World

  25. Three options for increasing domestic public HIV investment in Africa

  26. Projected resource needs (in USD billion) Assumed increases of domestic contributions by BRICS and others within “ability to pay” (economic growth and towards Abudja targets) Development Assistance 8.0 9.4 10.7 11.8 12.7 13.5 13.6 13.0 11.9 11.3 9.7 LI LMI Domestic financing UMI BRICS

  27. The beginning of the end of AIDS is in our hands

  28. Reaching people with services:Examples for 2015

  29. 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

  30. Testing and CounselingCoverage and cost per person

  31. OST Cost Assumptions Cost of Methadone: • 33c for 80mg in Iran to $2.06 for 80mg in Indonesia • About USD 1000 per person year • Going down by 20% in 2015 and by half in 2020

  32. Behavior Change Programmes • Little evidence for effectiveness • Little information on cost • As a proxy: cost workplace programs (by 2015, 50% coverage of the 148 million employees in the formal sector in countries with generalized epidemics, average unit cost of US$ 9 per employee per year)

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

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