6 Gaps in global antiretroviral coverage under the 2010 and 2013 WHO HIV treatment guidelines Total eligible:18,563,00028,600,0002010 guidelines*2013 guidelines*14,000,00066%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 treatmentEligible 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 scienceDrive progressGuide action beyond 2015Ultimately aspire to end the AIDS epidemicPhoto: UN General Assembly 2012
10 Challenges ahead: 1- Societal Lack of knowledge of HIV statusPunitive policies and lawsStigma and discrimination
11 Challenges ahead: 2- diverse facility level costs Cost of treatment per ART patient year by countryUS DollarsChallenges ahead: 2- diverse facility level costsSouth Africa*MaximumUS$682AverageUS$MinimumUS$278US$232US$186US$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 achieveProjected 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 MalawiLesothoZimbabweMozambiqueBurundiUgandaCentral African Rep.TanzaniaZambiaSwazilandKenyaLiberiaTogoRwandaSierra LeoneCameroonChadGuinea-BissauCôte d’IvoireBotswanaHaitiGuineaNamibiaDjiboutiNigeriaSouth AfricaBurkina FasoNigerBeninEritreaGhanaMaliCambodiaBelizeMyanmarSenegalART costs as a percentage of GDP5% – 8%2% – 5%1% – 2%0.1% – 1%12345678%Source: Williams arXiv 2012:
19 The tasks ahead Develop instruments (to support partners) ModellingCostingSupply forecastTesting campaignCountry consultationsRegional consultationsDialogue with key strategic partnersGlobal consensus meetingConsultations (Countries, regions, ad hoc)DemandResourcesProgressMonitoring and evaluationSource: Terhorst, D & Schmid, G., WHO 2006
20 Making it work: The African Union Roadmap Sustainable financing modelsAccess to medicines – Local production and regulatory harmonizationLeadership, governance and oversight