1. 1 |1 | Treatment 2.0 Catalyzing the Next Phase of Scale-up Gottfried Hirnschall Director, HIV Department WHO, Geneva

2. 2 |2 | Progress on ART Access 6.6 million on ART (end 2010) Global coverage ~40% 6.6 million on ART (end 2010) Global coverage ~40%

3. 3 |3 | Challenges to Narrowing the Treatment Gap Financing Complexity of treatment and monitoring Inefficiencies in service delivery Late presentation High rates of attrition 9,000,000

4. 4 |4 | Bold targets for 2015 Eliminate new HIV infections in children TB deaths among PLHIV reduced by 50% Intensify HIV prevention –men who have sex with men –people who inject drugs –sex workers 15 million people on ART

5. 5 |5 | Treatment 2.0 Achieving and Sustaining Universal Access and Maximizing the Preventive Benefits of ART Simplification Innovation Efficiency Accessibility and equity Affordability Decentralization and Integration Community involvement

6. 6 |6 | What’s New All released at this conference http://www.who.int/hiv/pub/guidelines/en /

7. 7 |7 | Framework for Action Radical simplification of treatment and care Continue scale up in cost neutral environment –Getting more efficient –Doing more (and better) with less Advocacy –Renewed commitment from Governments and donors –New science brings opportunity to turn the tide on the epidemic Short, medium and long-term –Goals and actions over 10 years

8. 8 |8 | Optimize Drug Regimens Target Product Profile: Safety/Efficacy Tolerability Durability Stability Convenience Special Populations Cost

9. 9 |9 | Optimize Drug Regimens: Short Term Priorities for Optimization (2011-2013) 1 st line in Adults and Adolescents –Tenofovir/3TC/Efavirenz in one pill once daily FDC 2nd line in Adults and Adolescents –Atazanavir/ritonavir + NRTI backbone in once daily FDC or interim blisterpack Paediatrics –Lopinavir/ritonavir sprinkles suitable for Infants and paediatric heat-stable RTV formulations, AZT/3TC dispersible formulations

10. 10 | Promote Point-of-Care Diagnostics CD4 Some POC on the market Viral Load No POC devices on the market yet Rapid HIV Testing and Early infant diagnosis SAMBA 1, NWGHF p24 Antigen rapid test TB and MDR TB Diagnosis Xpert MTB/RIF Cepheid GeneXpert multi-platform Slide courtesy of Maurine M. Murtagh and UNITAID

11. 11 | Point-of-care Diagnostics on the Market TB/MDR TB - GeneXpert – multi-platform –Rapid roll-out in South Africa –Commitment by producer to develop HIV viral load using same platform CD4 – PIMA, Point-Care –Pilot programs –Review in process for WHO prequalification Training, quality assurance, linkages to central laboratories remain a concern for scale-up of POC diagnostics

12. 12 | Adapting Delivery Systems Slide courtesy of Emily A. Bobrow, PhD, MPH Senior Research Officer Elizabeth Glaser Pediatric AIDS Foundation Linking and integrating health services provides people with the user-friendly care they need, when they need it Maximizing retention and health outcomes Providing better value for money

13. 13 | Next Steps for Treatment 2.0: Normative Guidance Development July 11, 2011 –Meeting on ARV innovation –Hosted by Chatham House, organized by Patent Pool, UNITAID and WHO –Innovator and generics industry, global and implementing partners August 2011 –Systematic reviews on key topics for short term ART optimization: 3TC/FTC compatibility Efavirenz and pregnancy Tenofovir in children August 2011 –Systematic reviews on decentralization and integration of HIV treatment with ANC, primary care and TB services –Initial planning on community and health services linkages case studies and report on two regional community consultations

14. 14 | Next Steps for Treatment 2.0: Normative Guidance Development (2) September 13-15 –Global consultation on retention in care and loss to follow-up October 3-5 –Global consensus meeting on priorities for advancing point-of-care diagnostics and other simplified monitoring platforms 2012 –Consensus meeting on medium & long term priorities for ARV optimization 2012/13 –Simplified, streamlined, “bundled” guidance on strategic use of ARVs to treat and prevent infection (ART adults, paediatrics, PMTCT, TB/HIV, PrEP and ART for prevention)

15. 15 | Advancing Science into Policy and Action  The science is clear - ARVs prevent transmission  Implementing ART for prevention and PrEP requires increased resources, improved efficiencies in service delivery and high rates of retention in care  Strategic combined prevention using ARVs with human rights protections, condoms, male circumcision, harm reduction and education/behaviour change can end the epidemic  Treatment 2.0 provides the platform for focused simplification, efficiencies and effectiveness of treatment  Research for a vaccine and a cure must be accelerated in parallel to implementation of proven interventions.  Resources, leadership, advocacy and partnership will determine how quickly we end the epidemic

16. 16 | Acknowledgments Craig McClure, Chris Duncombe, Marco Vitoria HIV Department, WHO, Geneva