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How can we get to zero? The potential contribution of treatment

How can we get to zero? The potential contribution of treatment Peter Godfrey-Faussett and Bernhard Schwartlander UNAIDS WHO Satellite Symposium, Kuala Lumpur 30 June 2013. Going to zero : . Investment thinking and tools New approaches and technologies Impact on new HIV infections

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How can we get to zero? The potential contribution of treatment

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  1. How can we get to zero? The potential contribution of treatment Peter Godfrey-Faussett and Bernhard Schwartlander UNAIDS WHO Satellite Symposium, Kuala Lumpur 30 June 2013

  2. Going to zero: Investment thinking and tools New approaches and technologies Impact on new HIV infections Impact on AIDS-related deaths

  3. The tool – apply investment thinking to your response: 4 simple steps 2 3 1 4 DESIGN DELIVER UNDERSTAND SUSTAIN Sustain for impact Know your epidemic The What: Focus on the right things The How: Doing things the right way to go to scale We are not starting from scratch! Virtually all countries have a national strategy The tool is meant to support countries to identify - and act upon - opportunities for improvement Towards an improved investment approach for an effective response to HIV/AIDS Lancet 2011 Bernhard Schwartländer, John Stover, Timothy Hallett, RifatAtun, Carlos Avila, Eleanor Gouws, Michael Bartos, Peter D Ghys, Marjorie Opuni, David Barr, RamziAlsallaq, Lori Bollinger, Marcelo de Freitas, Geoff rey Garnett, Charles Holmes, Ken Legins, Yogan Pillay, Anderson Eduardo Stanciole, Craig McClure, Gottfried Hirnschall, Marie Laga, Nancy Padian, on behalf of the Investment Framework Study Group*

  4. New investment framework (2011) – focus & simplification CRITICAL ENABLERS BASIC PROGRAMME ACTIVITIES OBJECTIVES Programs for keypopulations • Social enablers • Politicalcommitment & advocacy • Laws, policies & practices • Community mobilization • Stigma reduction • Mass media PMTCT Stopping new infections Behaviour Change Progr. Condoms Keeping people alive • Programmeenablers • Community-centereddesign & delivery • Programmecommunication • Management & incentives • Operations Research 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.

  5. The tool – apply investment thinking to your response: 4 simple questions 2 3 1 4 DESIGN DELIVER UNDERSTAND SUSTAIN Sustain for impact Know your epidemic The What: Focus on the right things The How: Doing things the right way to go to scale Where werethe last 1000infections (Who and Where)? Are there obvious mismatches? Cutting cost (cost drivers!) and efficiency in delivery Shared responsibility, innovative financing

  6. Spectrum and the Goals Model www.futuresinstitute.org

  7. Coverage Targets for 2015 for the Investment Framework (IF)

  8. Scenarios modeled • IFInvestment Framework - as described above • IFEEnhanced IF - with addition of new WHO consolidated ART guidelines • IFE +UT IFE with Universal Treatment = Treatment regardless of CD4 count • IFE + PrEPIFE with pre-exposure prophylaxis • IFE + Vaccine • IFE + UT + PrEP + Vaccine

  9. Scenario Definitions for New Prevention Technologies

  10. Going to Zero? The 2011 Investment Framework Combination prevention and treatment (current guidelines) Number of new HIV infections - Investment Framework

  11. Going to Zero? The 2011 Investment Framework Combination prevention and treatment (new guidelines) Number of new HIV infections - Investment Framework

  12. New technologies: critical in reaching zero new infections in both industrialized and LMI countries (e.g. vaccine) Number of new HIV infections - Investment Framework

  13. Zero new HIV infections? • “All models are wrong – but some are useful” • “Investment thinking” clear that treatment is an excellent investment and a cornerstone of the response • New WHO guidelines (IFE) likely to substantially reduce the size of the future epidemic • Treatment unlikely to be sufficient to achieve our goal of zero new infections • Continued push for research into vaccines, cures, easier (eg long-acting) treatments and PrEP

  14. Resource needs (crude) – different investment scenarios Billion US $ - Investment Framework - Investment Framework Enhanced (new WHO guidelines)

  15. Conclusions: A new paradigm in a replenishment dialogue • From cost to investments (in health) • The Investment Framework is not just a case for investment in HIV, it is about the “HOW” – how to maximise the returns • From “as much as possible” to: how can we invest for greatest impact; and how we can get the resources to do so • Shared responsibility • Value for money is a core value of country programmes • The GF can be the most powerful instrument to incentivize and support countries in investing strategically • It is possible to get on the path towards zero

  16. Going to Zero: Number of people on ART Different scenarios 2011 to 2050 Number of people on ART

  17. Going to Zero: Paths going to 15 by 50 Number of people on ART 15 million on ART

  18. Going to Zero: Paths going to 15 by 50 16 million deaths averted Number of people on ART 15 million on ART

  19. Going to zero. • Millions of lives to be saved by scaling up treatment efficiently • Immediate gains from prioritising those with advanced HIV • Access and coverage for all people eligible • Longer term gains from treating earlier – infections and co-morbidities averted • Impact on non-AIDS morbidity and mortality • Zero AIDS-related deaths

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