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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
Approach
Resources 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 20
Years Since Infection
Need TreatmentDead
Adult Male Progression with Treatment
0
10
20
30
40
50
60
0 2 4 6 8 10 12 14 16 18 20
Years Since Infection
On FLOn SLDead
Estimates of ARV Prices for First Line Regimens (US$)
0
200
400
600
800
1000
1200
2007 2008 2009 2010 2011 2012 2013 2014 2015
Brazil
Ukraine
Botswana
Peru, MexicoHonduras, SA
Tanzania
Estimates of ARV Prices for First Line Regimens (US$)
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$)
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
2007 2008 2009 2010 2011 2012 2013 2014 2015
Botswana, SA, Mexico, Tanzania
Honduras
Brazil
Ukraine
El Salvador
Estimates of ARV Prices for Second Line Regimens (US$)
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
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.
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