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“Towards an improved investment approach for an effective response to HIV “ The Lancet, June 3, 2011 www.thelancet.com. - PowerPoint PPT Presentation
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“Towards an improved investment approach for an effective response to HIV “
The Lancet, June 3, 2011www.thelancet.com
Moving from a commodity approach:“Fund some of everything” or“Fund what is comfortable”toAn Investment approach:“Fund evidenced-based activities specific to the needs of your epidemic to get better long term results at lower costs.”
A tool for evaluation and reallocation of HIV funding.
Three Categories of Investment:Six basic programmatic activities Critical interventions that create an
enabling environment for achieving maximum impact; and
Programmatic efforts in wider health and development sectors related to AIDS.
Rights-based approach to all services and policies
Basic programme activities Activities that have a direct impact
on reducing HIV transmission, morbidity and mortality to be scaled up according to size of relevant affected population
Basic Program Activities
Based on high level evidence of effectiveness.
Treatment, care and support Vertical Transmission prevention Condom procurement and
distribution Key populations programs (MSM,
IDU, Sex Workers) Male circumcision Behavior Change programs
Critical Enablers
Social Enablers - make possible environments conducive for sound AIDS responses:
outreach for HIV testing Linkage from testing to care treatment literacy stigma reduction advocacy to protect human rights monitoring of the equity and quality of
programme access and results
Critical Enablers
Program Enablers - create demand for and help improve the performance of key interventions:
incentives for engagement in health services methods to improve retention on ART capacity building for community-based
organizational development strategic planning communications infrastructure information dissemination efforts to improve service integration and
linkages from testing to care.
Synergies with other development sectors
Health systems and multiple health issues
Gender equality efforts Education and justice sectors Social protection and welfare Food security Community systems Housing
What is the Role of Community Mobilization in this Framework?
Community-driven outreach and engagement activities that connect people facing similar issues and engage them in HIV-related interventions
Support activities to enhance quality, adherence and impact in a range of settings such as people on treatment, engaged in harm reduction or drug treatment services, or who are using sexual and reproductive health services
Advocacy, transparency and accountability efforts at country and local levels to ensure that high-quality health services are available and accessible to vulnerable populations.
Community support keeps people on treatment
Source: Decroo T et al. Distribution of antiretroviral treatment through self-forming groups of patients in Tete province, Mozambique. Journal of Acquired Immune Deficiency Syndromes, 2010 [Epub ahead of print].
Source: Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review. Tropical Medicine and International Health, 2010, 15(Suppl. 1):1–15.
CLINIC-BASED TREATMENT
Sub-Saharan Africa: people receiving ART from specialist clinics
still receiving treatment after two years70%
COMMUNITY TREATMENT MODEL
Mozambique: self-initiated community model
still receiving treatment after two years98%
Sources: Fox MP, Rosen S. Tropical Medicine and International Health, 2010. Decroo T et al. Journal of Acquired Immune Deficiency Syndromes, 2010.
Community mobilization increases effectiveness
Community mobilisation increased HIV testing rates four-fold in Tanzania, Zimbabwe, South Africa and Thailand
Consistent condom use in the past 12 months was 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
Percentage of people retained in treatment and care after diagnosis, USA and Mozambique
Source: Gardner E M et al. Clin Infect Dis. 2011;52:793-800; Micek et al JAIDS 2009
Dignosed Linked to care Retained in care Eligible for ART Iniatiated ART Adherent/undetectable
Tested <30 days
MozambiqueUSA
Diagnosedwith HIV
Linked/enrolled in care
Eligiblefor ART
InitiatedART
Adherentor
undetectableRetained
in care
100%
0
Reta
ined
in
treat
men
t and
car
e
Percentage of people retained in treatment and care after diagnosis, USA and Mozambique
Source: Gardner E M et al. Clin Infect Dis. 2011;52:793-800; Micek et al JAIDS 2009
To improve testing: Reduce stigma in the community and in
healthcare settings Strengthen community support and
referral networks Enhance human rights literacy
Dignosed Linked to care Retained in care Eligible for ART Iniatiated ART Adherent/undetectable
Tested <30 days
MozambiqueUSA
Diagnosedwith HIV
Linked/enrolled in care
Eligiblefor ART
InitiatedART
Adherentor
undetectableRetained
in care
100%
0
Reta
ined
in
treat
men
t and
car
e
Percentage of people retained in treatment and care after diagnosis, USA and Mozambique
Source: Gardner E M et al. Clin Infect Dis. 2011;52:793-800; Micek et al JAIDS 2009
Improve enrolment in care: Expand community-centred
delivery Overcome cost & transport barriers Enhance treatment & rights literacy
Dignosed Linked to care Retained in care Eligible for ART Iniatiated ART Adherent/undetectable
Tested <30 days
MozambiqueUSA
Diagnosedwith HIV
Linked/enrolled in care
Eligiblefor ART
InitiatedART
Adherentor
undetectableRetained
in care
100%
0
Reta
ined
in
treat
men
t and
car
e
Percentage of people retained in treatment and care after diagnosis, USA and Mozambique
Source: Gardner E M et al. Clin Infect Dis. 2011;52:793-800; Micek et al JAIDS 2009
Get more people on treatment: Enhance peer support programmes Reduce costs Overcome transport barriers Ensure adequate nutrition Reduce stigma in healthcare settings
Dignosed Linked to care Retained in care Eligible for ART Iniatiated ART Adherent/undetectable
Tested <30 days
MozambiqueUSA
Diagnosedwith HIV
Linked/enrolled in care
Eligiblefor ART
InitiatedART
Adherentor
undetectableRetained
in care
100%
0
Reta
ined
in
treat
men
t and
car
e
Percentage of people retained in treatment and care after diagnosis, USA and Mozambique
Source: Gardner E M et al. Clin Infect Dis. 2011;52:793-800; Micek et al JAIDS 2009
Retain people on treatment: Adherence support programmes Reduce gender inequalities Reduce fear of disclosure Overcome cost and transport barriers Referral and support programmes for
migrants
Dignosed Linked to care Retained in care Eligible for ART Iniatiated ART Adherent/undetectable
Tested <30 days
MozambiqueUSA
Diagnosedwith HIV
Linked/enrolled in care
Eligiblefor ART
InitiatedART
Adherentor
undetectableRetained
in care
100%
0
Reta
ined
in
treat
men
t and
car
e
What can we achieve?
Universal Access by 2015
Projections and Estimates Resource needs and returns on investment were
estimated for 139 low- and middle-income countries Estimates based on the cost of increasing from
current levels of coverage in 2011 to achieve universal access target coverage levels by 2015 and maintain them thereafter. (Includes 1st and 2nd line treatment.)
Each of the basic programme activities in the framework was applied to relevant populations according to their demographic and epidemiological situation including the distribution of new HIV infections by mode of transmission as detailed in the literature.
Returns for InvestmentMore than 12 million Infections averted
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
New
HIV
infe
ctio
ns
Baseline Investment Framework
New infections averted between 2011 and 2020: 12.2 million
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
AID
S de
aths
Baseline Investment Framework
AIDS deaths averted between 2011 and 2020: 7.4 million
Return on investment of the new investment framework (2011-2020)
Outcomes
Total infections averted 12.2 million
Infant infections averted 1.9 million
Life years gained 29.4 million
Deaths averted 7.4 million
What will it cost?
What are the returns?
Financial requirements (Billions of US$)
2011 2015 2020Basic Programs 7.0 12.9 10.6Critical Enablers 5.9 3.4 3.7Synergies with Development Sectors 3.6 5.8 5.4Total 16.6 22.0 19.8
0
5
10
15
20
25
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Cos
t (bi
llion
s U
S$)
BaselineInvestment Framework
Economic returns between 2011 to 2020
Cost/ReturnsTotal additional investment (over 10 years) USD 46.5 Billion
Future treatment need averted USD 40 Billion
Life years gained $1,060 per life year gained