Transcript Slide 1

Towards an improved
investment approach for an
effective response to HIV
Dr Bernhard Schwartländer
UNAIDS
We have done a lot …
• Unprecedented scale up of services
• Decline in rate of new HIV infections in many
countries
• More than 6.5 M on ART
But we can do better
Scale up to date guided by “commodity approach”
• Unsystematic prioritisation and investment
• Resources spread thinly across many parallel
interventions
• Focus on discrete interventions rather than
overall results leading to a fragmented response
A shift in paradigm
Strategic investment based on
prioritisation and driven by latest evidence
What can we achieve?
Universal Access by 2015
ART coverage in 2015 by CD4 count
100%
CD4 350
90%
80%
15 million (T4P)
Coverage
70%
60%
50%
40%
13.1 million (health)
30%
20%
10%
0%
>500
350-499
250-349
200-249
100-199
CD4 Count (cells/ml)
50-99
<50
Reaching people with services:
Examples for 2015
Condoms (discordant couples)
Condoms (high risk pop)
Sex work
MSM programmes
IDU programmes
HIV testing
ART
Coverage
60%
50%
60%
60%
60%
Million
320
15
Return on investment:
More than 12 million infections averted
3,000,000
New HIV infections
2,500,000
2,000,000
New infections averted between 2011 and
2020: 12.2 million
1,500,000
1,000,000
500,000
0
2011
2012
2013
Baseline
2014
2015
2016
Investment Framework
2017
2018
2019
2020
Annual number of AIDS deaths:
2011-2020
2,500,000
AIDS deaths
2,000,000
AIDS deaths averted between 2011 and 2020:
7.4 million
1,500,000
1,000,000
500,000
0
2011
Life years gained
29.4 million
2012
2013
Baseline
2014
2015
2016
2017
2018
2019
2020
Investment Framework
9
What will it cost?
What are the returns?
Billions (US $)
Resources needed
for the investment framework
25
Synergies with
Development Sectors
Critical Enablers
20
Behaviour Change
Programs
Male circumcision
15
Treatment, care and
support
IDU
10
MSM
5
CSW and clients
Condom promotion
0
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
PMTCT
11
Economic cost and returns
2011 to 2020
Cost/Returns
Total additional investment
(over 10 years)
Future treatment need
averted
Life years gained
US$46.5 Billion
US$40 Billion
US$1,060
per life year gained
Conclusions
• Through a focused and committed approach we
can turn this epidemic around
• With an upfront investment over the coming 5
years, we will be able to turn cost around
• Time to overcome the false dichotomy between
prevention and treatment
• In line with the commitments and targets included
in the Declaration of the HLM AIDS
The Lancet Vol 377 June 11, 2011 - Available online at www.thelancet.com