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Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS vlima@cfenet.ubc

British Columbia Centre for Excellence in HIV/AIDS. What can we learn from the impact of dramatically scaling-up treatment on future costs and prevention efforts?. Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS vlima@cfenet.ubc.ca.

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Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS vlima@cfenet.ubc

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  1. British Columbia Centre for Excellence in HIV/AIDS What can we learn from the impact of dramatically scaling-up treatment on future costs and prevention efforts? Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDSvlima@cfenet.ubc.ca

  2. Rationale Evidence • MTCT (De Cock 2000; Coovadia 2009) • PEP (Pinkerton 2004, Fisher 2006) • Discordant Couples (Quinn 2000; Castilla 2005; Wawer 2005; Bechange 2008; Garnett 2008) • Population-based studies (Fang 2004; Lima 2007; Anema 2009) • Mathematical Models (Blower 2000; Law 2001; Abbas 2006; Montaner 2006; Lima 2007-2009; Granich 2009; De Cock 2009) HAART stops HIV replication  HIV levels fall to undetectable in blood as well as in sexual fluids  Sharp reduction in HIV transmission

  3. Evidence from British Columbia

  4. Lima V JID 2008 Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 2008; 198:59-67

  5. ex at the age of 20 years: 23.6 years Direct cost to treat each person with first-line therapy: $15,400 CAN Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 2008; 198:59-67

  6. Return on increased investment resulting from status quo approach versus 50% and 75% expansion scenarios Lima V JID 2008

  7. Current global ARV need

  8. Number of people receiving antiretroviral drugs in low- and middle-income countries (2002 - 2007) UNAIDS & WHO 2008

  9. UNAIDS & WHO 2008

  10. Funding gap between resource needs and resource availability (2005-2007) Needs Availability UNAIDS & WHO 2008

  11. Effect of PEPFAR on HIV Incidence

  12. Lima 2009

  13. Where do we go next?

  14. Scaling-up ART: Needs & Constraints → Cost (direct & indirect) → Limited Resources - How to prioritize the available funds? → Treatment Guidelines - When to start? - 1st & 2nd Line Therapy? - Laboratory Monitoring → Treatment of Co-morbidities & other Health Issues → Long-term Sustainability: Health Systems & Funding → Other Concurrent Prevention Efforts → Social & Gender Inequalities →Cultural & Governmental Barriers →Human Rights Issues …

  15. Thanks!

  16. Other slides

  17. Effect of PEPFAR on HIV Incidence

  18. Lima 2009

  19. Current global ARV need

  20. UNAIDS & WHO 2008

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