Brazzaville, Congo 5-7 March 2014 5th Inter-Agency Meeting on
Coordination and Harmonization of HIV/AIDS, TB and Malaria
Strategies
Slide 2
Treatment 2015 launch
Slide 3
The agreed target
Slide 4
.. and focusing on treatment is strategic
Slide 5
20152003 Treatment continues to expand
Slide 6
Gaps in global antiretroviral coverage under the 2010 and 2013
WHO HIV treatment guidelines Eligible but not receiving treatment
Eligible and receiving treatment Total eligible: *Numbers of people
receiving treatment in December 2012 versus (a) the numbers
eligible in December 2012 under the 2010 WHO guidelines; (b) the
numbers eligible in December 2013, under the 2013 WHO guidelines.
18,563,000 28,600,000 2010 guidelines*2013 guidelines* 14,000,000
66% 39%
Slide 7
Source: UNAIDS estimates 2013 Gap in antiretroviral coverage
varies within Africa
Slide 8
The agreed target is still ambitious and is a stepping stone
towards treatment for all in need
Slide 9
UNAIDS PCB calls for new targets Encompass new science Drive
progress Guide action beyond 2015 Ultimately aspire to end the AIDS
epidemic
Slide 10
Challenges ahead: 1- Societal Lack of knowledge of HIV status
Punitive policies and laws Stigma and discrimination
Slide 11
Cost of treatment per ART patient year by country US Dollars
Challenges ahead: 2- diverse facility level costs *Republic of
South Africa: costs include updated antiretroviral prices, which
were renegotiated by the RSA government in early 2010 and are 53%
lower than those observed during the costing period. US$ Average
Maximum Minimum US$136 US$186 US$232 US$278 US$682 South
Africa*
Slide 12
Challenges ahead: 3- treatment cascade Sources: 1. UNAIDS 2012
estimates; 2. Demographic and Health Surveys, 20072011
(www.measuredhs.com); 3. Kranzer, K., van Schaik, N., et al.
(2011), PLoS ONE; 4. GARPR 2012;www.measuredhs.com 5. Barth R E,
van der Loeff MR, et al. (2010), Lancet Infect Disease. Notes: No
systematic data are available for the proportion of people living
with HIV who are linked to care, although this is a vital step to
ensuring viral suppression in the community.
Slide 13
Challenges ahead: 4- delivery systems Relative likelihood of
HIV-positive adults (15-49 years) accessing antiretroviral therapy
due to the distance from their nearest primary healthcare facility.
Source: Location, Location: Connecting people faster to HIV
services, UNAIDS; Geneva, 2013
Slide 14
Challenges ahead: 5- Key populations and partners a substantial
share of new infections Nigeria 51% Kenya about 33% Mozambique more
than 25% Morocco 80% Dominican Rep. 47% Peru 65%
Slide 15
Expected impact of HIV treatment in survival of a 20 years old
person living with HIV in a high income setting (different periods)
HIV treatment can normalize survival
Slide 16
What we can achieve Projected annual AIDS-related deaths,
assuming scale up to 95% coverage by 2020
Slide 17
Expanding access to ART is a smart investment: Case of South
Africa Source: Expanding ART for Treatment and Prevention of HIV in
South Africa: Estimated Cost and Cost-Effectiveness 2011-2050. PLoS
ONE 7(2):e30216
Slide 18
With international support, universal access to ART is at reach
in low- and middle income countries Malawi Lesotho Zimbabwe
Mozambique Burundi Uganda Central African Rep. Tanzania Zambia
Swaziland Kenya Liberia Togo Rwanda Sierra Leone Cameroon Chad
Guinea-Bissau Cte dIvoire Botswana Haiti Guinea Namibia Djibouti
Nigeria South Africa Burkina Faso Niger Benin Eritrea Ghana Mali
Cambodia Belize Myanmar Senegal ART costs as a percentage of GDP
012345678% 2% 5% 5% 8% 0.1% 1% 1% 2% Source: Williams arXiv 2012:
http://arxiv.org/abs/1206.6774
Slide 19
The tasks ahead Source: Terhorst, D & Schmid, G., WHO 2006
Country consultations Regional consultations Dialogue with key
strategic partners Global consensus meeting Consultations
(Countries, regions, ad hoc) Develop instruments (to support
partners) Modelling Costing Supply forecast Testing campaign Demand
Resources Progress Monitoring and evaluation
Slide 20
Making it work: The African Union Roadmap Sustainable financing
models Access to medicines Local production and regulatory
harmonization Leadership, governance and oversight