Funding Mechanisms and the End of AIDS

Ending AIDS in Kenya

new drugs and faster treatment enrollment will cost effectively break the back of the epidemic.

New evidence has powerfully demonstrated that we can halt

new infections.

HIV Prevention Trials Network study 052: Tested to see if ART can prevent HIV transmission

between couples where one partner is living with HIV; and to determine when to initiate treatment. 1,763 serodiscordant couples at 13 sites in Botswana,

Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe. The study arms compared immediate ART initiation at

or below 500 CD4 versus delaying till 350 CD4

Rapid Steps to End AIDS in Kenya


HPTN 052 results: earlier ART initiation resulted in a reduction in new infections.

27 HIV transmissions occurred in the delayed treatment arm. Only one infection happened in the early treatment

arm, and appears to have happened at ART initiation, before ARVs could fully achieve viral suppression.

Myron S. Cohen et al, Prevention of HIV-1 Infection with Early Antiretroviral Therapy; N Engl J Med 2011 365:493-505 August 11, 2011

ART broadly benefits all of society--and costs are declining.

• For every 1000 patient-years of treatment provided:

• 228 people deaths averted

• 449 children not orphaned

• 61 sexual transmissions of HIV averted

• 26 vertical (mother-to-child) infections averted

• 9 TB cases averted among HIV patients

• 2,200 life-years gained.



Treatment’s Broad Benefits to Society:

Cost savings from avertednegative outcomes offset the major portion of total treatment program costs.

• Net estimated societal cost of treatment in 2011: $172 per discounted life-year gained.

Based on WHO standards for cost-effectiveness, ART is highly cost-effective in most of sub-Saharan Africa.

$M280.6

$M614.9

$M574.2

$M180.4

Costs Savings Attributable to ART

Averted non-ART treatment costs

Averted orphan care costs

Averted sexual transmissions

Averted vertical transmissions

Division of Global HIV/AIDS

Source: Center for Global Health


AIDS treatment more than pays for itself.

• By WHO standards for cost-effectiveness, ART is highly cost-effective in Kenya.

Hesch et al. (2011) compared treatment costs of 3.5 million people on ART supported by the Global Fund against the benefits of restored productivity for people able to work again, savings in unneeded orphan programmes, and averted costs for TB and other OIs.

• The financial saving of keeping these 3.5 million people alive and well would amount to between 85% and 240% of programme costs.

2010 Kenya GDP per capita GDP: US$1,689(Kshs 139,329) (World Bank PPP data)

Net estimated societal cost of treatment in 2011: $172 (Kshs 14,189) per discounted life-year gained.(Center for Global Health, Division of Global HIV/AIDS)

Resch S, Korenromp E, Stover J, Blakley M, Krubiner C, et al. 2011 Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries. PLoS ONE 6(10): e25310. doi:10.1371/journal.pone.0025310

But there’s more.


GAME CHANGING NEW DRUGS• TAF – tenofovir pro-drug, just entered phase III trials:• -Studies have shown decreased renal and bone metabolism

toxicity as compared to TDF• -Can use 1/10 the mg dose - so potential for lower cost• -May retain activity in the setting of some common TDF

mutations.

• DTG-finally an integrase inhibitor:• -Most effective ART at bringing down VL rapidly• -Theoretically cheap• -Very potent - people don't fail often and

don't fail with mutations• -Once daily• -Increasing evidence for safety in kids


Landmark 052 results are magnifiedby CDC modeling of accelerating

treatment scale up. The current pace of ART scale-up in Kenya will continue to

incur rising costs, and is not sufficient to outpace new infections.

At the September PEPFAR Scientific Advisory Board, CDC presented a model gauging the impact of accelerating AIDS treatment enrollmentin Kenya.

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KENYA: With Accelerated Scale-Up, an Additional 323,000 are Moved to Treatment from

Current Clinical Care and PMTCT

Based on population estimates in the following priority populations: patients already in care with CD4<500, PMTCT patients, HIV patients with active TB, known PLHA in sero-discordant couples

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200

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2010 2011 2012 2013 2014 2015

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Base Case Accelerated Scale-Up

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Accelerated Scale-Up Results in Annual Decline in New HIV Infections – 31% by 2015

Under the base-case scenario, incident HIV infections remain relatively constant at or above 120,000 new cases per year. With accelerated treatment scale-up, incident HIV infections could be driven down to ~86,500 by 2015.

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20,000

40,000

60,000

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2010 2011 2012 2013 2014 2015

Accelerated Scale-up

Base Case

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Under Accelerated ART Enrollment, Significant Savings Result Over Status Quo:

Estimated costs to maintain current coverage levels in the Base Case and Accelerated Scale-Up Scenario. Flattened treatment costs in the accelerated scale-up scenario reflect effects of declining HIV incidence and additional implementation efficiency.

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$100

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2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Accelerated Scale-Up

Base Case

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s


Treating more people faster has dramatic benefits.

By quickly enrolling PLHIV above current baselines of ART scale-up in Kenya, CDC concluded that, by treating 900,000 by 2015:

New infections would decline by 31% by 2015And costs are reduced below current

levels, up to 33%


Treating more people faster is the cheapest option.

Net costs=treatment costs minus costs averted:• greatly reduced new infections• medical costs for HIV-related illness and opportunistic infections• orphan care• sustained productivity for workers and families• increasing service delivery efficiencies• shrinking drug unit costs• spill-over health systems benefits and synergies


Kenya and Development Partners Must Update Guidelines and Budget to Accelerate Treatment Scale-up:

Treat all serodiscordant couples regardless of CD4 as per new WHO guidelines. Start the wheels in motion for new ARVs now! Lifelong ART for all pregnant/nursing women

nationwide—this year!! ART for all active TB patients Earlier Initiation at 500 CD4 Greater use of viral load--comparable costs to CD4!


Kenya and its Development Partners must pay now,

or pay more later.

Kenya must increase health spending health to comply with PEPFAR Partnership Framework commitments by Treasury to increase domestic health budgets by at least 10% annuallyfrom 2010-2013.

PEPFAR must sustain it’s funding commitments under the Partnership Framework. We cannot reach six million by 2013 if OGAC breaks PPF commitments to Kenya.

Donor countries must increase contributions to the Global Fund. With Round 11 delayed, Kenya should lead other African countries to call for an emergency replenishment conference before the IAS in Washington.

Blueprint for an AIDS-Free Generation:

• “UPFRONT costs associated w scaling up combo prevention are substantial, but these investments do not result in ever-increasing costs. in fact, the impact of up-front investments is a decline & then a flattening of out-year costs, as fewer new services are needed and the number of new infections falls substantially.”

• “PEPFAR is firmly committed to help countries move beyond the tipping point”

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Blueprint for an AIDS-Free Generation:

Thank You Minister:

“To reap the full benefits of this year’s scientific breakthroughs, we shall, together with our development partners, endeavour to put one million people with HIV on treatment by the end of 2015, scaling up from the current 460,000. This is a challenge that the country is willing to tackle since its success will reduce the heavy disease burden that the country has carried since the emergence of the HIV epidemic. The additional resources Kenya is willing to commit to the fight against HIV and AIDS will result in significant cost-savings later.”

“We believe that expanding HIV treatment to reach all Kenyans in need is one viable way to both break the back of the HIV epidemic and sustainably fund the fight against HIV.”

-Hon Minister of Special Programmes Esther Murugi

Funding Mechanisms and the End of AIDS

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