1. Resource requirements for reaching the treatment goals under PEPFAR XV International AIDS Conference Bangkok July 15, 2004 Owen Smith, Abt Associates Inc. Gilbert Kombe, Abt Associates Inc.

2. Introduction and Objectives The Presidents Emergency Plan for AIDS Relief (PEPFAR): PEPFAR targets Treat 2 million people with ARVs by 2008 Prevent 7 million new infections by 2008 Provide care to 10 million individuals by 2008 Budget of $15 billion $10 billion of this is new money, of which $1 billion is for the Global Fund; 55% of the remainder is ear-marked for treatment Key questions for study: Is the budget adequate for achieving the stated targets? What are the human resource requirements? Findings can help inform policy decisions

3. Assumptions and Methods Assumed the goal of reaching 2 million on ARVs by 2008 is achieved in equal steps each year, starting in 2004 Calculations include drugs, monitoring tests, labor, training, and capital The cost of key supporting services is also included: voluntary counseling and testing (VCT) and treatment of opportunistic infections (OIs) Some pediatric and 2 nd line treatment included Data was collected through primary sources in Uganda and Zambia, interviews with providers, and from international sources

4. Methods (continued) Per patient results indicate that drugs and monitoring tests account for most costs; labor, training, and capital costs were small in comparison Therefore explored two scenarios: Low drug costs ($300 per patient on 1 st line per year) High drug costs ($600 per patient on 1 st line per year)

5. Reaching targets within PEPFAR budget Number of ARV patients under low and high drug cost scenarios

6. Human resource requirements As drug prices fall and donor funding rises, there is increased focus on other potential obstacles to expansion Quantifying financial needs is done frequently; quantifying human resource needs is much less common Explore two scenarios for the number of doctors required to provide ARVs: 90 minutes of doctor time per ARV patient per year 45 minutes of doctor time per ARV patient per year

7. Human resource requirements Share of doctor workforce required to achieve PEPFAR goals

8. Human resource requirements Share of doctor workforce required to reach full coverage by 2013

9. Conclusions Drug prices will be an important determinant of the feasibility of reaching PEPFAR goals within the budget The human resource constraint could be more important in certain countries than the financial constraint; pursuing the many options for improving HR capacity should be an urgent priority Key uncertainties in ARV costing: Drug prices Rate of attrition to second line treatment Uptake of VCT services in a large-scale ARV program setting OI costs: reduced or delayed? Impact of ARV expansion on prevention efforts (long-term)

10. Partners for Health Reformplus project USAID Office of the Global AIDS Coordinator Institute of Medicine (U.S.) POLICY project Thank you