1. 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

2. 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 HIV treatment
targets, modeling analysis projects that
VMMCs conducted to date will avert more than
240,000 HIV infections by PEPFAR continues
to prioritize this one-time intervention
by increasing central funding to this intervention
in 2015.
© Bill & Melinda Gates Foundation |

3. 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 |

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

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

6. ADVOCACY and demand creation
© Bill & Melinda Gates Foundation |

7. 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 |

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

9. 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 |

10. 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 |