FUNDING SLOWDOWN
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FUNDING SLOWDOWN. if : 1. But we can do better. We have done a lot…. 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

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But we can do better

We have done a lot…

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

  • 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

BUILDS ON PAST, BUT DOES BETTER

if : 2


IF : 3 AIDS Investment Framework

CRITICAL ENABLERS

BASIC PROGRAMME ACTIVITIES

OBJECTIVES

Programmes

for keypopulations

PMTCT

  • Social enablers

  • Laws & policies

  • Community mobilization

  • Stigma reduction

Stopping new infections

Behaviour

change

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



Investment framework projections for new HIV infections

Optimized investment will lead to rapid declines in new HIV infections in many countries




Art coverage in 2015 by cd4 count

100%

100%

90%

90%

80%

80%

70%

70%

60%

60%

Coverage

Coverage

50%

50%

40%

40%

30%

30%

20%

20%

10%

10%

0%

0%

>500

>500

350-499

350-499

250-349

250-349

200-249

200-249

100-199

100-199

50-99

50-99

<50

<50

CD4 Count (cells/ml)

CD4 Count (cells/ml)

ART coverage in 2015 by CD4 count

CD4 350

15 million

13.1 million (health)

T4P


Cost per patient per year weighted average in us
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


Development synergies

Synergies and enablers – distinct, but overlapping

HIV-sensitive

(HIV outcome is one of many objectives)

HIV-specific

(sole/primary objective is an HIV outcome)

Critical enablers


Community mobilization
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
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
Community mobilization: makes scale up possible framework

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 mobilization: framework increases effectiveness

  • Community mobilisation increased HIV testing rates four-fold 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


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