Brazzaville, Congo 5-7 March 2014 5th Inter-Agency Meeting on Coordination and Harmonization of HIV/AIDS, TB and Malaria Strategies Brazzaville, Congo 5-7 March 2014

Treatment 2015 launch

The agreed target…

.. and focusing on treatment is strategic

Treatment continues to expand 2003 2015

Gaps in global antiretroviral coverage under the 2010 and 2013 WHO HIV treatment guidelines Total eligible: 18,563,000 28,600,000 2010 guidelines* 2013 guidelines* 14,000,000 66% 39% *Numbers of people receiving treatment in December 2012 versus (a) the numbers eligible in December 2012 under the 2010 WHO guidelines; (b) the numbers eligible in December 2013, under the 2013 WHO guidelines. Eligible but not receiving treatment Eligible and receiving treatment

Gap in antiretroviral coverage varies within Africa Source: UNAIDS estimates 2013

The agreed target is still ambitious… …and is a stepping stone towards treatment for all in need

UNAIDS PCB calls for new targets Encompass new science Drive progress Guide action beyond 2015 Ultimately aspire to end the AIDS epidemic Photo: UN General Assembly 2012

Challenges ahead: 1- Societal Lack of knowledge of HIV status Punitive policies and laws Stigma and discrimination

Challenges ahead: 2- diverse facility level costs Cost of treatment per ART patient year by country US Dollars Challenges ahead: 2- diverse facility level costs South Africa* Maximum US$682 Average US$ Minimum US$278 US$232 US$186 US$136 *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.

Challenges ahead: 3- treatment cascade Sources: 1. UNAIDS 2012 estimates; 2. Demographic and Health Surveys, 2007–2011 (www.measuredhs.com); 3. Kranzer, K., van Schaik, N., et al. (2011), PLoS ONE; 4. GARPR 2012; 5. Barth R E, van der Loeff MR, et al. (2010), Lancet Infect Disease. Notes: No systematic data are available for the proportion of people living with HIV who are linked to care, although this is a vital step to ensuring viral suppression in the community.

Challenges ahead: 4- 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

Challenges ahead: 5- Key populations and partners a substantial share of new infections Nigeria 51% Kenya about 33% Mozambique more than 25% Morocco 80% Dominican Rep. 47% Peru 65%

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)

What we can achieve Projected annual AIDS-related deaths, assuming scale up to 95% coverage by 2020

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 2011-2050. PLoS ONE 7(2):e30216

With international support, universal access to ART is at reach in low- and middle income countries Malawi Lesotho Zimbabwe Mozambique Burundi Uganda Central African Rep. Tanzania Zambia Swaziland Kenya Liberia Togo Rwanda Sierra Leone Cameroon Chad Guinea-Bissau Côte d’Ivoire Botswana Haiti Guinea Namibia Djibouti Nigeria South Africa Burkina Faso Niger Benin Eritrea Ghana Mali Cambodia Belize Myanmar Senegal ART costs as a percentage of GDP 5% – 8% 2% – 5% 1% – 2% 0.1% – 1% 1 2 3 4 5 6 7 8% Source: Williams arXiv 2012: http://arxiv.org/abs/1206.6774

The tasks ahead Develop instruments (to support partners) Modelling Costing Supply forecast Testing campaign Country consultations Regional consultations Dialogue with key strategic partners Global consensus meeting Consultations (Countries, regions, ad hoc) Demand Resources Progress Monitoring and evaluation Source: Terhorst, D & Schmid, G., WHO 2006

Making it work: The African Union Roadmap Sustainable financing models Access to medicines – Local production and regulatory harmonization Leadership, governance and oversight