Transcript IF : 1 FUNDING SLOWDOWN IF : 2 BUILDS ON PAST, BUT DOES BETTER WE HAVE DONE A LOT… But we can do better •

IF : 1
FUNDING SLOWDOWN
IF : 2
BUILDS ON PAST, BUT DOES BETTER
WE HAVE DONE A LOT…
But we can do better
• Unprecedented scale up of HIV
prevention, treatment, care and
support
• Decline in rate of new HIV infections
in many countries
• More than 6.6 million people on ART
• Millions of orphans receiving basic
education, health, social protection
Scale up to date guided by a
“commodity approach”



Unsystematic prioritisation and
investment with limited basis in
country epidemiology and context
Resources spread thinly across
many parallel interventions
Focus on discrete interventions
rather than overall results leading
to a fragmented response
IF : 3
CRITICAL
ENABLERS
Social enablers
• Laws & policies
• Community mobilization
• Stigma reduction
AIDS Investment Framework
BASIC PROGRAMME ACTIVITIES
Programmes
for key
populations
Behaviour
change
PMTCT
OBJECTIVES
Stopping new
infections
Condoms
Programme enablers
• Community-centered
design & delivery
• Management & incentives
• Production & distribution
• Research & innovation
Keeping people
alive
Care &
treatment
Male
circumcision
SYNERGIES WITH DEVELOPMENT SECTORS
Social protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence;
Health systems (incl. treatment of STIs, blood safety); Community systems; Employment practices.
Social enablers
•
•
•
•
•
•
Political commitment & advocacy
Laws, policies & practices
Community mobilization
Stigma reduction
Mass media
Local responses, to change risk environment
• Local responses, to change risk environment
Programme enablers
• Community-centered design & delivery
• Programme communication
• Management & incentives
• Production & distribution
•Research & innovation
IF : 4
THE RETURN ON INVESTMENT
Investment framework projections for new HIV
infections
Optimized investment will lead to rapid declines in new HIV infections in many countries
IF: 5
ALLOCATIVE EFFICIENCY
IF : 6
SHARED RESPONSIBILITY
ART coverage in 2015 by CD4 count
100%
CD4 350
90%
80%
15 million
Coverage
70%
60%
50%
40%
30%
13.1 million (health)
T4P
20%
10%
0%
>500
350-499
250-349
200-249
100-199
CD4 Count (cells/ml)
50-99
<50
Cost per patient per year
(weighted average in US$)
2010
2015
2020
Lab (new patients)
180
129
79
Lab (cont patients)
180
128
76
Service delivery
176
144
112
1st Line ARVs
155
147
57
2nd Line ARVs
1678
984
295
Critical enablers and development synergies:
• are necessary but not sufficient by themselves for
effective AIDS responses, by supporting basic programme
activities
• encourage sustainability of AIDS responses through
integration into other non-health sectors
• are determined and prioritized by country contexts,
• require mechanisms for multi-sectoral financing and
governance
Synergies and enablers – distinct, but overlapping
Development
synergies
HIV-specific
(sole/primary
objective is an
HIV outcome)
HIV-sensitive
(HIV outcome
is one of many
objectives)
Critical
enablers
Community Mobilization
• Little information on cost
• Country reviews (USD 1 to 14 per adult
population)
• Community Health Workers (@ USD 2 per
adult population)
Community mobilization assumptions in the
investment framework
Cost envelope: community mobilisation component of the
critical enablers
2011 $0.3bn
2015 $0.6 bn
2020 $1.0 bn
Assumptions:
• Increased community capacity
• increased community service delivery
• need for remuneration of community and lay workers
• need for training, guidance, supervision
• participation of people living with HIV
Community mobilization: makes scale up possible
• Number of people tested through community
mobilization
2010: 46 million (VCT)
2015: 109 million
• Service delivery costs (treatment)
2010: $179 per year
2020: $125 per year ($17 in low income countries)
• Driving costs down: fewer outpatient visits,
community support service modalities
• Better Health Outcomes
Community mobilization:
increases effectiveness
• Community mobilisation increased HIV testing rates fourfold in Tanzania, Zimbabwe, South Africa and Thailand.
• Consistent condom use in past 12 months 4 times higher in
communities with good community engagement (Kenya)
• Hypothetical circumcision model KwaZulu-Natal :
– core intervention: 240,000 infections averted over ten years
– with enablers: 420,000 infections averted, with modest marginal
increase in costs