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Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS [email protected] PowerPoint PPT Presentation


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British Columbia Centre for Excellence in HIV/AIDS. What can we learn from the impact of dramatically scaling-up treatment on future costs and prevention efforts?. Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS [email protected]

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Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

British Columbia

Centre for Excellence

in HIV/AIDS

What can we learn from the impact of dramatically scaling-up treatment on future costs and prevention efforts?

Viviane Dias Lima

British Columbia Centre for Excellence in [email protected]


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Rationale Evidence

  • MTCT (De Cock 2000; Coovadia 2009)

  • PEP (Pinkerton 2004, Fisher 2006)

  • Discordant Couples (Quinn 2000; Castilla 2005; Wawer 2005; Bechange 2008; Garnett 2008)

  • Population-based studies (Fang 2004; Lima 2007; Anema 2009)

  • Mathematical Models (Blower 2000; Law 2001; Abbas 2006; Montaner 2006; Lima 2007-2009; Granich 2009; De Cock 2009)

HAART stops HIV replication

HIV levels fall to undetectable in blood as well as in sexual fluids

Sharp reduction in HIV transmission


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Evidence from British Columbia


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Lima V JID 2008

Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 2008; 198:59-67


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

ex at the age of 20 years: 23.6 years

Direct cost to treat each person with first-line therapy: $15,400 CAN

Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 2008; 198:59-67


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Return on increased investment resulting from status quo approach versus 50% and 75% expansion scenarios

Lima V JID 2008


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Current global ARV need


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Number of people receiving antiretroviral drugs in low- and middle-income countries (2002 - 2007)

UNAIDS & WHO 2008


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

UNAIDS & WHO 2008


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Funding gap between resource needs and resource availability

(2005-2007)

Needs

Availability

UNAIDS & WHO 2008


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Effect of PEPFAR on HIV Incidence


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Lima 2009


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Where do we go next?


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Scaling-up ART: Needs & Constraints

→ Cost (direct & indirect)

→ Limited Resources - How to prioritize the available funds?

→ Treatment Guidelines - When to start?

- 1st & 2nd Line Therapy?

- Laboratory Monitoring

→ Treatment of Co-morbidities & other Health Issues

→ Long-term Sustainability: Health Systems & Funding

→ Other Concurrent Prevention Efforts

→ Social & Gender Inequalities

→Cultural & Governmental Barriers

→Human Rights Issues


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Thanks!


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Other slides


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Effect of PEPFAR on HIV Incidence


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Lima 2009


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

Current global ARV need


Viviane dias lima british columbia centre for excellence in hiv aids vlima cfenet ubc

UNAIDS & WHO 2008


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