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HIV Therapy for the Developing World: A Global Health Challenge

HIV Therapy for the Developing World: A Global Health Challenge. Harold W. Jaffe, MD Department of Public Health University of Oxford Oxford, UK. Adults and children estimated to be living with HIV 2006. Eastern Europe & Central Asia 1.7 million. Western & Central Europe 740,000.

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HIV Therapy for the Developing World: A Global Health Challenge

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  1. HIV Therapy for the Developing World: A Global Health Challenge Harold W. Jaffe, MD Department of Public Health University of Oxford Oxford, UK

  2. Adults and children estimated to be living with HIV 2006 Eastern Europe & Central Asia 1.7 million Western & Central Europe 740,000 North America 1.4 million East Asia 750,000 North Africa & Middle East 460,000 Caribbean 250,000 South & South-East Asia 7.8 million Sub-Saharan Africa 24.7 million Latin America 1.7 million Oceania 81,000 Total: 39.5 (34.1- 47.1) million

  3. Estimated adult and child deaths from AIDS 2006 Eastern Europe & Central Asia 84,000 Western & Central Europe 12,000 North America 18,000 East Asia 43,000 North Africa & Middle East 36,000 Caribbean 19,000 South & South-East Asia 590,000 Sub-Saharan Africa 2.1 million Latin America 65,000 Oceania 4,000 Total: 2.9 (2.5 – 3.5) million

  4. HIV prevalence (%) in adults in Africa, 2005

  5. Impact of AIDS on life expectancy in five African countries, 1970–2010 70 65 60 Botswana 55 South Africa Life expectancy at birth (years) 50 45 Swaziland 40 35 Zambia 30 Zimbabwe 25 20 1970–1975 1980–1985 1990–1995 2000–2005 1975–1980 1985–1990 1995–2000 2005–2010 Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database.

  6. Estimated Annual GDP Loss Attributed to HIV/AIDS, 1992-2002 CountryLoss in US$ (millions) Botswana 270 South Africa 7,230 Swaziland 102 Zambia 127 Zimbabwe 638 International Labour Organisation, United Nations: HIV and Work: Global estimates, impact and response, 2004

  7. Patients on HAART Deaths per 100 PY Mortality and HAART Use Over Time HIV Outpatient Study, CDC, 1994-2003

  8. Daily Cost of Antiretroviral Drugs 3TC/d4T/Nevirapine 1The Medical Letter 2006;4:67 2UNAIDS, April 2007

  9. The President’s Emergency Plan for AIDS Relief • Announced January 28, 2003 • 15 focus countries • Goals: • Treat 2 million HIV-infected people • Prevent 7 million new HIV infections • Provide care for 10 million HIV-infected people and AIDS orphans • Overall budget for global AIDS: • $15 billion over 5 years • ($10 billion new money)

  10. ARV Therapy in Low and Middle Income Countries: December 2006 68% of the total unmet need

  11. Challenges in Implementing ARV Programs in Developing Countries • Lack of knowledge of HIV infection status • Need for new care models • Lack of trained personnel • Laboratory support • Corruption/maintenance of supply chain

  12. The Global Challenge of HIV/AIDSUnanswered Questions in the ARV era • Can a prevention focus be maintained? • What happens when ARV resistance emerges? • Can ARV programs upgrade medical infrastructure? • Will staff and resources be diverted from other critical programs? • Can ARV programs be sustained?

  13. 9 000 8 000 7 000 6 000 5 000 4 000 ( US$ millions ) 3 000 Global Fund World Bank MAP Launch 2 000 Signing of Declaration of Commitment on HIV/AIDS 1 000 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Source: Lancet, 2006; 368: 526–30 Estimated total annual resources available for AIDS, 1996–2005 PEPFAR

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