1. 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

2. Treatment 2015 launch

3. The agreed target…

4. .. and focusing on treatment is strategic

5. Treatment continues to expand
2003
2015

6. 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 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

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

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

9. 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

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

11. 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.

12. Challenges ahead: 3- treatment cascade
Sources: 1. UNAIDS 2012 estimates; 2. Demographic and Health Surveys, 2007–2011 ( 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.

13. 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

14. 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 %

15. 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)

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

17. 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 PLoS ONE 7(2):e30216

18. 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:

19. 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

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