1. Prioritizing Advanced HIV Disease and Overcoming Barriers to Access Carolyn Amole Senior Director, HIV Access Program, CHAI
Satellite: Saving Lives Today: Accelerating Access to Diagnostics and Drugs for Advanced HIV Disease

2. There is an ineffective global response to advanced HIV disease (AHD), and an urgent need to accelerate access to critical, life-saving products for diagnosis, prevention, and treatment of AHD
Reduction in HIV-related mortality has stagnated globally, in spite of increased ART coverage and a reduction in the number of new infections.
Number of AHD related deaths globally ( )
Number of AHD related deaths
In 2016, UN member states agreed to the target of cutting deaths from AIDS to less than 500,000 per year.
In 2018, there were 770,000 AIDS-related deaths. With six months until 2020 we are far from achieving the target. 1

3. 10% will die within 3 months
Advanced HIV disease remains a persistent challenge globally for both newly initiating patients and increasingly for ART experienced patients as well
People living with HIV presenting to care
1 in 3 people living with HIV present to care with advanced disease
10% will die within 3 months
An increasing proportion of those presenting with AHD are ART experienced 2
Source: WHO Management of Advanced Disease Guidelines, 2017.

4. Coordinate the market for AHD commodities
The Unitaid Advanced HIV Disease Initiative, implemented by CHAI, aims to reduce morbidity and mortality and improve cost efficiencies by accelerating access to affordable, optimal products for preventing, testing and treating key opportunistic infections
Project Countries
Malawi, Nigeria,
South Africa, Tanzania, Uganda
and some support in Botswana and Lesotho
Reduce the price of priority health products through supply-side market interventions
Coordinate the market for AHD commodities
Unitaid-CHAI Advanced HIV Disease Initiative
Accelerate product introduction and build demand for AHD commodities through catalytic procurement and adoption and rollout support
Jan – Dec. 2020
Priority Health Products
CD4
TB urine-LAM
CrAg LFA rapid test
Diagnostic
TB prevention therapy
Amphotericin B (classic and liposomal)
Flucytosine
Fluconazole
Therapeutics 3

5. A number of key barriers are limiting access on both demand and supply sides of the market to these critical AHD commodities (CD4, TB LAM, CrAg LFA, TPT, AmB and L-AmB, 5FC, Fluc)
Demand Barriers
Supply Barriers
CD4 deprioritized in favor of funding VL scale-up limits AHD case-finding
Gaps in national guidelines lead to uncoordinated implementation of the AHD package of care
Lack of registration of LAmB and 5FC
Poor implementation of elements of the AHD package of care, including inadequate training and facility readiness
Poor community engagement and lack of AHD awareness
Poor visibility around the size of the CM treatment market
Lack of economies of scale due to small, fragmented, and unpredictable demand
High prices and long lead times for critical commodities
Lack of prioritization of AHD commodities in donor procurement plans
Limited supplier base for AHD diagnostic and treatment products 4

6. Key insights from across focal countries are shaping our strategy to accelerate market access and enable successful implementation
CD4 is the critical gateway for AHD diagnosis and treatment, but there is limited use of CD4 for AHD screening at baseline and in cases of treatment failure
Key insights from in-country AHD engagement
Utilization of sustainable procurement mechanisms, such as the Global Fund’s Wambo platform, will assist in transition of procurement and support greater long-term sustainability for countries
Scale-up of the AHD package of care requires a coordinated capacity-based approach that leverages existing capability and expertise in country
Implementation support from partners for training and capacity building will be required to enable successful national scale-up 5

7. Facility Level Support
CHAI and partners are working with governments across the product introduction pathway to facilitate rapid introduction of critical AHD commodities in countries
Building the investment case for AHD, and updating national AHD treatment guidelines based on WHO package of care
Community engagement
and sensitization on AHD, and development of patient literacy materials on AHD
Coordination of partners to ensure a capacity-focused AHD package of care
Adoption
Product Registration
Procurement
Community Engagement
Transition Planning
Facility Level Support
Monitoring Uptake
Support product registration of AHD commodities
Support catalytic procurement in countries and work with suppliers to ensure sustainable supply at affordable pricing
MoH-led AHD implementation plans; develop AHD materials trainings and job aides
Include AHD commodities in all stock and patient monitoring and reporting tools 6

8. As countries scale up the AHD package of care, it is essential to ensure that strong training and tools are in place to facilitate proper use and drive countries towards the ultimate goal of reducing morbidity and mortality
Coming Soon: The AHD Toolkit A consortium of partners are working to bring together a consolidated set of AHD materials that are openly accessible for countries to adopt and contextualize for their national AHD programs.
Toolkit Highlights
HCW training package to diagnose and treat AHD both in hospital and  ambulatory care
Clinical workshops
Patient flow manuals
Adherence counselling tools
Facility posters
AHD Toolkit
Text
Programmatic
Tools
Job aids
SOPs
Training
materials
Community
sensitization
With contributions from: 7

9. -CAB meeting participant
CHAI and Unitaid partnered with AfroCAB to launch a new community initiative for AHD, kicking off with a Community Advisory Board meeting held in South Africa in March
Community Advisory Board (CAB)
Over 40 participants from 12 countries discussed civil society's role in building demand around HIV treatment, diagnostics, and AHD.
CAB meeting in Pretoria, South Africa
“The information and knowledge gained in these CAB meetings has been invaluable. The knowledge acquired has enabled the CAB members to be effective in their work and bring this knowledge back to others. It felt like we were the experts.”  
-CAB meeting participant 8

10. “If you want to go fast, go alone. If you want to go far, go together
“If you want to go fast, go alone. If you want to go far, go together.” Partnership on AHD will be essential to ensuring that we go far – and fast – in achieving our goals of reducing AIDS-related deaths.
Unitaid and CHAI have established an AHD Implementation Steering Committee to ensure effective coordination of efforts among implementers and funders. Chaired by WHO, the role of the AHD Implementation Steering Committee is to:
Track progress on AHD activities and provide strategic input to ensure activities best meet the needs of PLHIV
Enable collaboration where there are synergies between organizations
Share evidence, experience, and learnings
Work in collaboration to advocate for increased focus on addressing mortality at both global and country levels
Committee members include:
This initiative is calling on all partners – including governments, donors, suppliers, implementing partners & the HIV community – to join together to fight advanced HIV disease 9

11. Thank you! CHAI’s work in Advanced HIV Disease
is made possible by the generous support and partnership of Unitaid
Thanks to the CHAI team – James Conroy, Richard Borain, Ikechukwu Amamilo, Katie Lamp, and Tara Schoenborn for contributing to this presentation, and a big thanks to Benvy Caldwell for leading the planning for this satellite session. 10