IF : 1 FUNDING SLOWDOWN

IF : 2 BUILDS ON PAST, BUT DOES BETTER WE HAVE DONE A LOT… Unprecedented scale up of HIV prevention, treatment, care and support Decline in rate of new HIV infections in many countries More than 6.6 million people on ART Millions of orphans receiving basic education, health, social protection But we can do better Scale up to date guided by a “commodity approach”  Unsystematic prioritisation and investment with limited basis in country epidemiology and context  Resources spread thinly across many parallel interventions  Focus on discrete interventions rather than overall results leading to a fragmented response

IF : 3 AIDS Investment Framework SYNERGIES WITH DEVELOPMENT SECTORS CRITICAL ENABLERS Care & treatment Male circumcision Keeping people alive Programmes for key populations OBJECTIVES Stopping new infections BASIC PROGRAMME ACTIVITIES Social enablers Laws & policies Community mobilization Stigma reduction Programme enablers Community-centered design & delivery Management & incentives Production & distribution Research & innovation Social protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence; Health systems (incl. treatment of STIs, blood safety); Community systems; Employment practices.

Social enablers Political commitment & advocacy Laws, policies & practices Community mobilization Stigma reduction Mass media Local responses, to change risk environment Programme enablers Community-centered design & delivery Programme communication Management & incentives Production & distribution Research & innovation

IF : 4 THE RETURN ON INVESTMENT

Investment framework projections for new HIV infections Optimized investment will lead to rapid declines in new HIV infections in many countries

IF: 5 ALLOCATIVE EFFICIENCY

IF : 6 SHARED RESPONSIBILITY

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% > <50 CD4 Count (cells/ml) Coverage ART coverage in 2015 by CD4 count 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% > <50 CD4 Count (cells/ml) Coverage 13.1 million (health) CD million T4P

Cost per patient per year (weighted average in US$) Lab (new patients) Lab (cont patients) Service delivery st Line ARVs nd Line ARVs

Critical enablers and development synergies: are necessary but not sufficient by themselves for effective AIDS responses, by supporting basic programme activities encourage sustainability of AIDS responses through integration into other non-health sectors are determined and prioritized by country contexts, require mechanisms for multi-sectoral financing and governance

HIV-specific (sole/primary objective is an HIV outcome ) HIV-sensitive (HIV outcome is one of many objectives) Critical enablers Development synergies Synergies and enablers – distinct, but overlapping

Little information on cost Country reviews (USD 1 to 14 per adult population) Community Health Workers USD 2 per adult population) Community Mobilization

Community mobilization assumptions in the investment framework Cost envelope: community mobilisation component of the critical enablers 2011 $0.3bn 2015 $0.6 bn 2020 $1.0 bn Assumptions: Increased community capacity increased community service delivery need for remuneration of community and lay workers need for training, guidance, supervision participation of people living with HIV

Community mobilization: makes scale up possible Number of people tested through community mobilization 2010: 46 million (VCT) 2015: 109 million Service delivery costs (treatment) 2010: $179 per year 2020: $125 per year ($17 in low income countries) Driving costs down: fewer outpatient visits, community support service modalities Better Health Outcomes

Community mobilization: increases effectiveness Community mobilisation increased HIV testing rates four- fold in Tanzania, Zimbabwe, South Africa and Thailand. Consistent condom use in past 12 months 4 times higher in communities with good community engagement (Kenya) Hypothetical circumcision model KwaZulu-Natal : – core intervention: 240,000 infections averted over ten years – with enablers: 420,000 infections averted, with modest marginal increase in costs