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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, DC February 22, 2008. Purpose.

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Methods for estimating global resource needs for hiv aids 2008 2015

Methods for Estimating Global Resource Needs for HIV/AIDS 2008-2015

John Stover, Lori Bollinger

International AIDS Economic Network Meeting, Washington, DC

February 22, 2008


Purpose
Purpose 2008-2015

  • 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
Goals and Scenarios 2008-2015

  • 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
Components of a Comprehensive Program 2008-2015

  • Prevention

  • Care and treatment

  • Support for orphans and vulnerable children

  • National program costs

  • International support costs


Prevention programs

Vulnerable populations 2008-2015

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 Programs


Prevention of violence against women
Prevention of Violence Against Women 2008-2015

  • 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
Approach 2008-2015

Resources required =

population in need x

coverage x

unit cost


Key questions about unit costs
Key Questions About Unit Costs 2008-2015

  • What are the sources of information?

  • Do unit costs remain constant?

  • What has been costed?


Source of information on unit costs
Source of Information on Unit Costs 2008-2015

  • Published studies

  • RNM and Goals applications

  • National plans

  • Unit cost surveys

    • UNFPA Young People

    • UNAIDS/UNICEF OVC

  • RNM regional workshops

  • Regional averages


Validation
Validation 2008-2015

  • Top 15 validation workshop in Geneva

  • Latin America validation workshop in Mexico


Economies of scale
Economies of Scale? 2008-2015

  • 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
What has been costed? 2008-2015

  • “Resources needs” implies high quality programs

  • Difficult to tell what unit costs include

  • Key area for future work


Care and treatment

ART 2008-2015

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

Care and Treatment


Spectrum aids impact module aim
Spectrum: AIDS Impact Module (AIM) 2008-2015

Prevalence trends

New HIV Infection

NormalM 7.5yrs/F 8.5yrs, fast 6.1/6.9

Need for Treatment

3 years

First Line ART

AIDS Death

15% FY / 5% SY

15%/5%

Second Line ART




Estimates of arv prices for first line regimens us
Estimates of ARV Prices for First Line Regimens (US$) 2008-2015

Brazil

Ukraine

Botswana

Peru, Mexico

Honduras, SA

Tanzania


Estimates of arv prices for first line regimens us1
Estimates of ARV Prices for First Line Regimens (US$) 2008-2015

By 2015 typical first line becomes EFV+TDF+3TC


Estimates of arv prices for second line regimens us
Estimates of ARV Prices for Second Line Regimens (US$) 2008-2015

El Salvador

Ukraine

Brazil

Honduras

Botswana, SA, Mexico, Tanzania



Orphans and vulnerable children
Orphans and Vulnerable Children 2008-2015

  • 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 2008-2015

Program management

IEC & advocacy

M&E including OR

Training

Logistics and supply

Lab upgrading

Supervision and patient tracking

Drug resistance surveillance

Human resources

National Program Costs


International support costs
International Support Costs 2008-2015

  • Civil society strengthening

  • Technical assistance

  • Global advocacy and coordination

  • Policy, human rights, stigma


Major challenges
Major Challenges 2008-2015

  • 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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