Facilitating development and adaptation of the right tools Innovations needed to support Treatment for All: From incremental to game-changing AIDS 2016 19 July 2016 Peter Ehrenkranz, MD, MPH Senior Program Officer © 2014 Bill & Melinda Gates Foundation

The example of Routine viral load monitoring: from “0 to 90” in just a few short years How did this momentum build? How do we capitalize on this momentum such that the “right” tools are developed and adapted? Can the momentum be sustained such that the third 90 can be achieved? How can we build momentum to tackle other challenges and develop new tools? Assuming each country reaches the 90-90-90 HIV treatment targets, modeling analysis projects that VMMCs conducted to date will avert more than 240,000 HIV infections by 2025. PEPFAR continues to prioritize this one-time intervention by increasing central funding to this intervention in 2015. © Bill & Melinda Gates Foundation |

How did this momentum BUILD? Broad recognition of the value of viral load as a tool providing benefit to the: Individual – identifying stable vs not stable and acting on results Population– evaluation of epidemic control Health care system -- possibility of higher quality, more patient-centered, more efficient care Normative guidance and strong evidence Proactive funding Manufacturers seeing a market and being willing to negotiate on price A few positive examples of successful high coverage—Botswana, Kenya, South Africa Civil society advocacy (knowyourviralload.org) © Bill & Melinda Gates Foundation |

normative guidance and strong evidence of BENEFIT A Phillips, 2015 © Bill & Melinda Gates Foundation |

MONITORING the EPIDEMIC/ASsuring quality © Bill & Melinda Gates Foundation | Personal communication, S Carmona, NHLS.

ADVOCACY and demand creation www.knowyourviralload.org © Bill & Melinda Gates Foundation |

How do we capitalize on this momentum such that the “right” tools are developed and adapted? Bring countries and implementers together to: Describe and document successful models of how current tools have been adapted Create partnerships amongst countries with different strengths Catalyze a faster scale up that will produce not just test results, but will actually lead to changes in patient care. Identify outstanding questions and priorities that can inform further adaption of existing tools and development of new tools © Bill & Melinda Gates Foundation |

Advice from Kenya to Zimbabwe: “JUST START” ~6% VL coverage ~70% VL coverage © Bill & Melinda Gates Foundation |

Can the momentum be sustained and the third 90 achieved? Procurement Supply Chain Sample referral Governance Human resources Infrastructure Data systems A lab is more than new technology Funding Quality management Only by supporting the whole lab system and recognizing importance of non-lab factors like patient engagement. © Bill & Melinda Gates Foundation |

How can we build momentum to tackle other challenges and develop new tools? Develop standards to guide strengthening of laboratory systems Support south-to-south learning and knowledge sharing Use quality improvement methods to ensure that technology is used to improve clinical outcomes Focus on the end-user-- establish a cadre of clinical, laboratory, and community leaders who can capture on-the-ground experiences and participate in ongoing dialogue with donors and manufacturers © Bill & Melinda Gates Foundation |