“In a situation where we don’t know better, we do everything or just what we like …”
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“Towards an improved investment approach for an effective response to HIV “ The Lancet, June 3, 2011 www.thelancet.com
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“Towards an improved investment approach for an effective response to HIV “ The Lancet, June 3, 2011 www.thelancet.com. - PowerPoint PPT Presentation
Transcript of “In a situation where we don’t know better, we do everything or just what we like …”
“Towards an improved investment approach for an effective response to HIV “
The Lancet, June 3, 2011www.thelancet.com
Moving from a commodity approach:“Fund some of everything” or“Fund what is comfortable”
to
An Investment approach:“Fund evidenced-based activities specific to the needs of your epidemic to get better long term results at lower costs.”
“In a situation where we don’t know better, we do everything or just what we like …”
Three Categories of Investment:Six basic programmatic activities Critical interventions that create an
enabling environment for achieving maximum impact; and
Programmatic efforts in wider health and development sectors related to AIDS.
Rights-based approach to all services and policies
Basic programme activities Activities that have a direct impact
on reducing HIV transmission, morbidity and mortality to be scaled up according to size of relevant affected population Interventions that directly affect
incidence, morbidity and mortality (eg. ART, MC, NSP)
Complex interventions for which there is plausible evidence (eg. behaviour change programmes)
Basic Program Activities
Based on high level evidence of effectiveness.
Treatment, care and support Vertical Transmission prevention Condom procurement and
distribution Key populations programs (MSM,
IDU, Sex Workers) Male circumcision Behavior Change programs
Critical Enablers
Social Enablers - make possible environments conducive for sound AIDS responses:
outreach for HIV testing treatment literacy, stigma reduction, advocacy to protect human rights monitoring of the equity and quality
of programme access and results
Critical Enablers
Program Enablers - create demand for and help improve the performance of key interventions:
incentives for engagement in health services methods to improve retention on ART capacity building for community-based
organizational development strategic planning communications infrastructure information dissemination efforts to improve service integration and
linkages from testing to care.
David
Still need to address where HIV testing fits into all this - part of testing costs are included in Basic (provided initiated testing is part of tx/care/support. VCT is included as an enabling service. Don't we have definitive data showing VCT as a necessary and effective component of treatment/care/support?
Synergies with other development sectors
Health systems and multiple health issues
Gender equality efforts Education and justice sectors Social protection and welfare Food security Community systems
What is the Role of Community Mobilization in this Framework?
Community-driven outreach and engagement activities that connect people facing similar issues and engage them in HIV-related interventions
Support activities to enhance quality, adherence and impact in a range of settings such as people on treatment, engaged in harm reduction or drug treatment services, or who are using sexual and reproductive health services
Advocacy, transparency and accountability efforts at country and local levels to ensure that high-quality health services are available and accessible to vulnerable populations.
What can we achieve?
Universal Access by 2015
Projections and Estimates Resource needs and returns on investment were
estimated for 139 low- and middle-income countries Estimates based on the cost of increasing from
current levels of coverage in 2011 to achieve universal access target coverage levels by 2015 and maintain them thereafter. (Includes 1st and 2nd line treatment.)
Each of the basic programme activities in the framework was applied to relevant populations according to their demographic and epidemiological situation including the distribution of new HIV infections by mode of transmission as detailed in the literature.
Reaching people with servicesExamples for 2015
CoveragePMTCT 90%Condoms (discordant couples) 60%Condoms (high risk pop) 50%Sex work 60%MSM programmes 60%IDU programmes 60%
MillionHIV testing 320ART (CD4 350, T4P) 14
Returns for InvestmentMore than 12 million Infections averted
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
New
HIV
infe
ctio
ns
Baseline Investment Framework
New infections averted between 2011 and 2020: 12.2 million
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
AID
S de
aths
Baseline Investment Framework
AIDS deaths averted between 2011 and 2020: 7.4 million
Return on investment of the new investment framework (2011-2020)
Outcomes
Total infections averted 12.2 million
Infant infections averted 1.9 million
Life years gained 29.4 million
Deaths averted 7.4 million
Achieving global goals by 2015
Elimination of new infections in children
Sexual transmission down by half TB deaths down by half AIDS related maternal mortality
down by half 14 million PLHIV on treatment
What will it cost?
What are the returns?
Financial requirements (Billions of US$)
2011 2015 2020Basic Programs 7.0 12.9 10.6Critical Enablers 5.9 3.4 3.7Synergies with Development Sectors 3.6 5.8 5.4Total 16.6 22.0 19.8
0
5
10
15
20
25
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Cos
t (bi
llion
s U
S$)
BaselineInvestment Framework
Economic returns between 2011 to 2020
Cost/ReturnsTotal additional investment (over 10 years) USD 46.5 Billion
Future treatment need averted USD 40 Billion
Life years gained $1,060 per life year gained
