5th Inter-Agency Meeting on Coordination and Harmonization
of HIV/AIDS, TB and Malaria Strategies
Brazzaville, Congo
5-7 March 2014
Treatment 2015 launch
The agreed target…
.. and focusing on treatment is strategic
Treatment continues to expand
15
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2003
2012 2013 20142015
2015
Gaps in global antiretroviral coverage under the 2010
and 2013 WHO HIV treatment guidelines
Total eligible:
14,000,000
28,600,000
100%
50%
*Numbers of people receiving treatment in
December 2012 versus
39%
(a) the numbers eligible in December 2012
under the 2010 WHO guidelines;
(b) the numbers eligible in December
2013, under the 2013 WHO guidelines.
0%
2010 guidelines*
Eligible and receiving treatment
Eligible but not receiving treatment
66%
18,563,000
2013 guidelines*
Gap in antiretroviral coverage varies within Africa
Source: UNAIDS estimates 2013
The agreed target is still ambitious…
…and is a stepping stone towards treatment for all in need
UNAIDS PCB calls for new targets
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•
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Encompass new science
Drive progress
Guide action beyond 2015
Ultimately aspire to end the AIDS epidemic
Challenges ahead: 1- Societal
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Lack of knowledge of HIV status
Punitive policies and laws
Stigma and discrimination
Challenges ahead: 2- diverse facility level costs
$1,200
Maximum
$1,000
$800
Average
US$
US$682
$600
Minimum
$400
US$278
US$232
$200
US$186
US$136
$0
Malawi
Ethiopia
Rwanda
Zambia
*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.
RSA
South
Africa*
Challenges ahead: 3- treatment cascade
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.
Sources: 1. UNAIDS 2012 estimates; 2. Demographic and Health Surveys, 2007–2011 (www.measuredhs.com); 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.
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
Challenges ahead: 5- Key populations and partners
a substantial share of new infections
 Nigeria
 Kenya
 Mozambique
 Morocco
 Dominican Rep.
 Peru
51%
about 33%
more than 25%
80%
47%
65%
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)
What we can achieve
Projected annual AIDS-related deaths, assuming scale up to 95% coverage by 2020
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 2011-2050. PLoS ONE 7(2):e30216
ART costs as a percentage of GDP
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
5% – 8%
2% – 5%
1% – 2%
0.1% – 1%
0
1
2
3
4
Source: Williams arXiv 2012: http://arxiv.org/abs/1206.6774
5
6
7
8%
The tasks ahead
Develop instruments
(to support partners)

Modelling
 Costing
 Supply forecast
 Testing campaign
Consultations
(Countries, regions, ad hoc)

Country consultations
 Regional consultations
 Dialogue with key
strategic partners
 Global consensus
meeting
Monitoring and
evaluation

Demand
 Resources
 Progress
Source: Terhorst, D & Schmid, G., WHO 2006
Making it work:
The African Union Roadmap
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Sustainable financing models
Access to medicines – Local production and regulatory
harmonization
Leadership, governance and oversight