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Brazzaville, Congo 5-7 March 2014

5th Inter-Agency Meeting on Coordination and Harmonization of HIV/AIDS, TB a nd Malaria Strategies. Brazzaville, Congo 5-7 March 2014. Treatment 2015 launch. The agreed target…. .. a nd focusing on treatment is strategic. Treatment continues to expand. 2003. 2015.

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Brazzaville, Congo 5-7 March 2014

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  1. 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 14,000,000 28,600,000 Total eligible: *Numbers of people receiving treatment in December 2012 versus (a) the numbers eligible in December 2012 under the 2010 WHO guidelines; (b) the numbers eligible in December 2013, under the 2013 WHO guidelines. 66% 18,563,000 39% 2010 guidelines* 2013 guidelines* Eligible and receiving treatment Eligible but not 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

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

  11. Cost of treatment per ART patient year by country US Dollars Challenges ahead: 2- diverse facility level costs Maximum Average US$682 US$ Minimum US$278 US$232 US$186 US$136 South Africa* *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 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.

  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 partnersa substantial share of new infections • Nigeria 51% • Kenya about 33% • Mozambique more than 25% • Morocco 80% • Dominican Rep. 47% • Peru 65%

  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 2011-2050. PLoS ONE 7(2):e30216

  18. With international support, universal access to ART is at reach in low- and middle income countries Malawi Lesotho 5% – 8% Zimbabwe Mozambique Burundi Uganda Central African Rep. 2% – 5% Tanzania Zambia Swaziland Kenya Liberia Togo Rwanda 1% – 2% Sierra Leone Cameroon ART costs as a percentage of GDP Chad Guinea-Bissau Côte d’Ivoire Botswana Haiti Guinea Namibia Djibouti Nigeria South Africa 0.1% – 1% Burkina Faso Niger Benin Eritrea Ghana Mali Cambodia Belize Myanmar Senegal 0 1 2 3 4 5 6 7 8% Source: Williams arXiv 2012: http://arxiv.org/abs/1206.6774

  19. The tasks ahead Monitoring and evaluation Develop instruments(to support partners) • Modelling • Costing • Supply forecast • Testing campaign • Demand • Resources • Progress Consultations(Countries, regions, ad hoc) • Country consultations • Regional consultations • Dialogue with key strategic partners • Global consensus meeting 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

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