Methods for Estimating Global Resource Needs for HIV/AIDS 2008-2015

John Stover, Lori Bollinger

International AIDS Economic Network Meeting, Washington,

DCFebruary 22, 2008

Purpose Estimate the global resource needs

from all sources to implement a comprehensive program of HIV prevention, care, treatment and mitigation in low- and middle-income countries through 2015

Goals and Scenarios Universal access by 2010

Universal access to prevention, care and mitigation in all countries by 2010

Phased Scale Up to Universal Access

UA by 2010 for MARP and all services in hyper-endemic countries, by 2015 in generalized epidemics, current scale up elsewhere

Current Scale Up Continue current rates of scale

up to 2015

UNAIDS, Financial Resources Required to Achieve Universal Access to HIV Prevention, Treatment, Care and Support, September 2007.

Components of a Comprehensive Program

Prevention Care and treatment Support for orphans and

vulnerable children National program costs International support costs

Prevention Programs Vulnerable populations

Sex workers MSM IDU Prisoners Other special populations Youth (in/out of school) Formal sector employees

Behavior change Community mobilization Mass media Social marketing VCT Condoms Violence against women

Medical services Blood safety STI treatment PMTCT Post-exposure prophylaxis Safe medical injection Universal precautions

New technologies Male circumcision HSV-2 suppressive therapy Pre-exposure prophylaxis Microbicides Vaccines

Prevention of Violence Against Women

Workplace Community mobilization Education and sensitivity

training for adolescents Enabling environment

(special populations) Gender perspective in

health services Mass media Post-rape services NGO strengthening

ApproachResources required =

population in need x coverage x unit cost

Key Questions About Unit Costs

What are the sources of information?

Do unit costs remain constant?

What has been costed?

Source of Information on Unit Costs

1. Published studies2. RNM and Goals

applications3. National plans4. Unit cost surveys

1. UNFPA Young People2. UNAIDS/UNICEF OVC

5. RNM regional workshops

6. Regional averages

Validation Top 15 validation

workshop in Geneva

Latin America validation workshop in Mexico

Economies of Scale? Not much

information on economies of scale as programs expand

We assumed unit costs decline by 30% with each doubling of scale for most prevention interventions

Marseille E, et al. HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries BMC Health Services Research 2007, 7:108.

What has been costed? “Resources needs” implies high

quality programs Difficult to tell what unit costs

include Key area for future work

Care and Treatment ART

Drug costs FL, SL, Pediatric,

HIV-TB Laboratory costs Nutrition

supplements Service delivery

Non-ART Palliative care OI treatment Cotrimoxazole OI prophylaxis PITC STI screening Counseling

Spectrum: AIDS Impact Module (AIM)

New HIV Infection

Need for Treatment

First Line ARTAIDS Death

Second Line ART

Normal M 7.5yrs/F 8.5yrs, fast 6.1/6.9

3 years

15%/5%

15% FY / 5% SY

Prevalence trends

Adult Male Progression without Treatment

0

20

40

60

80

100

0 2 4 6 8 10 12 14 16 18 20Years Since Infection

Need TreatmentDead

Adult Male Progression with Treatment

0102030405060

0 2 4 6 8 10 12 14 16 18 20Years Since Infection

On FLOn SLDead

Estimates of ARV Prices for First Line Regimens (US$)

0

200

400

600

800

1000

1200

2007 2008 2009 2010 2011 2012 2013 2014 2015

Brazil

Ukraine

BotswanaPeru, MexicoHonduras, SATanzania

Estimates of ARV Prices for First Line Regimens (US$)

0

200

400

600

800

1000

1200

2007 2008 2009 2010 2011 2012 2013 2014 2015

By 2015 typical first line becomes EFV+TDF+3TC

Estimates of ARV Prices for Second Line Regimens (US$)

01,0002,0003,0004,0005,0006,0007,0008,000

2007 2008 2009 2010 2011 2012 2013 2014 2015

Botswana, SA, Mexico, Tanzania

HondurasBrazilUkraine

El Salvador

Estimates of ARV Prices for Second Line Regimens (US$)

01,0002,0003,0004,0005,0006,0007,0008,000

2007 2008 2009 2010 2011 2012 2013 2014 2015

Middle-income

Low-income

Orphans and Vulnerable Children

Who is vulnerable?

How are services delivered?

What should be included in AIDS resource needs?

Stover J et al. Resource needs to support orphans and vulnerable children in sub-Saharan Africa Health Policy and Planning 2007;22:21-27.

National Program Costs Health facilities Program

management IEC & advocacy M&E including OR Training

Logistics and supply

Lab upgrading Supervision and

patient tracking Drug resistance

surveillance Human resources

International Support Costs

Civil society strengthening Technical assistance Global advocacy and coordination Policy, human rights, stigma

Major Challenges Aligning unit costs

with ‘best practices’ Matching resource

needs with estimated expenditures

GRNE = national strategic plan budgets

Who should pay?

UNAIDS, Financial Resources Required to Achieve Universal Access to HIV Prevention, Treatment, Care and Support, September 2007.