A smart and doable investment
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- Liliana Todd
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1 A smart and doable investment
2 As of December 2013 Adults and children living with HIV Adults and children newly infected Adult & child deaths due to AIDS 35.0 million [33.2 million 37.2 million] 2.1 million [1.9 million 2.4 million] 1.5 million [1.4 million 1.7 million]
3 The other side of the story New infections Deaths due to AIDS 38% decrease 35% decrease ]
4
5
6 Rapid Treatment Scale up Prevents death Prevents new HIV infection Saves money
7 HIV treatment can normalize survival Expected impact of HIV treatment in survival of a 20 years old person living with HIV in a high income setting (different periods)
8 Dramatic impact of HIV response on life expectancy years Source: World Bank life expectancy data Slide courtesy D Birx, PEPFAR
9 PARTNER study: No transmission when viral load undetectable 1110 serodiscordant couples Two-year interim analysis shows no cases where someone with a viral load under 200 copies/ml transmitted HIV
10 Incidence rate ratio A clear correlation between HIV treatment and incidence 1.1% (0.8%-1.4%) reduction in HIV incidence, for each 1.0% increase in treatment coverage p=0.325 p=0.003 p= p= ART & HIV incidence: Hlabisa, South Africa 0% 30% 60% ART coverage Source: Tanser et al. Science 2013;339:
11 Expanding access to ART is a smart investment: Case of South Africa Source: Expanding ART for Treatment and Prevention of HIV in South Africa: Estimated Cost and Cost-Effectiveness PLoS ONE 7(2):e30216
12 Treatment continues to expand
13 Treatment continues to expand
14 UNAIDS PCB calls for new targets Targets drive progress New scientific evidence Post 2015 Accountability A winnable challenge
15 The choices Status quo Continue the current pace WHO 2013 guidelines Rapid scale-up to universal access
16 The treatment target
17 The new treatment paradigm 90% 81% 73% Single target Cascade target Death Death and transmission Number Equity Incremental funding Frontload Investments
18 Global ART coverage 37% Adults and children Source: UNAIDS 2014
19 Antiretroviral coverage varies by region 51% 21% 42% Western and Central Europe and North America 11% Eastern Europe Central Asia 33% Caribbean Middle East and North Africa Asia and Pacific 45% 37% Latin America Sub-Saharan Africa Source: UNAIDS estimates 2014
20 90% of HIV+ people tested is possible
21 HIV+ population tested at least once Women Men 0 Burkina Faso 2010 Burundi 2010 Cameroon 2011 Zimbabwe Ethiopia 2011 Uganda 2011 Malawi 2010 Rwanda 2010 Source: Demographic and Health Surveys
22 90% of eligible people on treatment is possible
23 high coverage in several countries 72% Brazil 71% Botswana Brazil UNGASS Country Progress Report (2012) UNAIDS Situation Room
24 Record number of people who tested positive for HIV went on to access ARV HIV, Sub-Saharan Africa 90% Source: UNAIDS 2014
25 90% virally suppressed is possible
26 Site A Site B Site C Site D Site E Site F Site G Site H Site I Site J Site K Site L Site M Site N Site O Site P Site Q Site R Site S Site T Total Proportion (95% CI) of patients with undetectable VL in a nationally representative sample of HIV-infected adults on ART in Rwanda % 80.00% 83% 60.00% 40.00% 20.00% Source: Basinga P et al. (2013) PLoS
27 Preparedness is key
28 Challenges ahead: 1- Societal Lack of knowledge of HIV status Punitive policies and laws Stigma and discrimination
29 Source: UNAIDS / National Commitments and Policy Instrument (NCPI)
30 Challenges ahead: 2- delivery systems Relative likelihood of HIV-positive adults (15-49 years) accessing antiretroviral therapy due to the distance from their nearest primary healthcare facility. Source: Location, Location: Connecting people faster to HIV services, UNAIDS; Geneva, 2013
31 US$ Challenges ahead: 3- diverse facility level costs $1,200 Maximum $1,000 $800 US$682 Average $600 $400 Minimum $200 US$136 US$186 US$232 US$278 $0 Malawi Ethiopia Rwanda Zambia RSA South Africa* *Republic of South Africa: costs include updated antiretroviral prices, which were renegotiated by the RSA government in early 2010 and are 53% lower than those observed during the costing period.
32 Scenario 1: Countries adopt new guidelines for both VL and CD4 Tests (MM) Global CD4 need Global VL need Source: Clinton Health Access Initiative, 2013 New WHO Guidelines go into effect: Routine VL for ART monitoring 32
33 Scenario 2: WHO recommends a universal Test and Offer approach Tests (MM) Global CD4 need Global VL need Source: Clinton Health Access Initiative, 2013 WHO: Test and Offer
34 Predicted VL scale up will not meet the need % 51% 45% 32% 38% 23% 28% Global VLforecast Global VL need Source: Clinton Health Access Initiative, 2013
35 The share of Lab portfolio varies by country 4% 9% 6% 5% 15% Malawi Ethiopia Rwanda Zambia RSA ARVs Personnel Lab Other Source: ASLM
36
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