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Towards an improved investment approach for an effective response to HIV. Dr Bernhard Schwartländer UNAIDS. We have done a lot …. Unprecedented scale up of services Decline in rate of new HIV infections in many countries More than 6.5 M on ART But we can do better - PowerPoint PPT Presentation
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Towards an improved investment approach for an
effective response to HIV
Dr Bernhard SchwartländerUNAIDS
We have done a lot …• Unprecedented scale up of services• Decline in rate of new HIV infections in many
countries • More than 6.5 M on ART
But we can do betterScale up to date guided by “commodity approach”• Unsystematic prioritisation and investment • Resources spread thinly across many parallel
interventions• Focus on discrete interventions rather than
overall results leading to a fragmented response
A shift in paradigm
Strategic investment based on prioritisation and driven by latest evidence
What can we achieve?
Universal Access by 2015
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
>500 350-499 250-349 200-249 100-199 50-99 <50
CD4 Count (cells/ml)
Cove
rage
ART coverage in 2015 by CD4 count
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
>500 350-499 250-349 200-249 100-199 50-99 <50
CD4 Count (cells/ml)
Cove
rage
13.1 million (health)
CD4 350
15 million (T4P)
Reaching people with services:Examples for 2015
CoverageCondoms (discordant couples) 60%Condoms (high risk pop) 50%Sex work 60%MSM programmes 60%IDU programmes 60%
MillionHIV testing 320ART 15
Return on investment:More than 12 million infections averted
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
New
HIV
infe
ctio
ns
Baseline Investment Framework
New infections averted between 2011 and 2020: 12.2 million
9
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
AID
S de
aths
Baseline Investment Framework
AIDS deaths averted between 2011 and 2020: 7.4 million
Annual number of AIDS deaths: 2011-2020
Life years gained 29.4 million
What will it cost?
What are the returns?
11
Resources needed
for the investment framework
0
5
10
15
20
25
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Bill
ions
(US
$)
Synergies withDevelopment SectorsCritical Enablers
Behaviour ChangeProgramsMale circumcision
Treatment, care andsupportIDU
MSM
CSW and clients
Condom promotion
PMTCT
Economic cost and returns 2011 to 2020
Cost/ReturnsTotal additional investment (over 10 years) US$46.5 Billion
Future treatment need averted US$40 Billion
Life years gained US$1,060 per life year gained
Conclusions
• Through a focused and committed approach we can turn this epidemic around
• With an upfront investment over the coming 5 years, we will be able to turn cost around
• Time to overcome the false dichotomy between prevention and treatment
• In line with the commitments and targets included in the Declaration of the HLM AIDS
The Lancet Vol 377 June 11, 2011 - Available online at www.thelancet.com
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