IF : 1FUNDING SLOWDOWN

IF : 2BUILDS ON PAST, BUT DOES BETTER

WE HAVE DONE A LOT…

• Unprecedented scale up of HIV prevention, treatment, care and support

• Decline in rate of new HIV infections in many countries

• More than 6.6 million people on ART• Millions of orphans receiving basic

education, health, social protection

But we can do better

Scale up to date guided by a “commodity approach”

Unsystematic prioritisation and investment with limited basis in country epidemiology and context

Resources spread thinly across many parallel interventions

Focus on discrete interventions rather than overall results leading to a fragmented response

IF : 3 AIDS Investment Framework

SYNERGIES WITH DEVELOPMENT SECTORS

CRITICAL ENABLERS

Care & treatment

Male circumcision

Keeping people alive

Programmes for keypopulations

PMTCT

Condoms

OBJECTIVES

Stopping new infections

Behaviourchange

BASIC PROGRAMME ACTIVITIES

Social enablers• Laws & policies• Community mobilization• Stigma reduction

Programme enablers• Community-centered

design & delivery• Management & incentives• Production & distribution• Research & innovation

Social protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence; Health systems (incl. treatment of STIs, blood safety); Community systems; Employment practices.

Social enablers• Political commitment & advocacy• Laws, policies & practices• Community mobilization• Stigma reduction• Mass media• Local responses, to change risk environment

• Local responses, to change risk environment

Programme enablers• Community-centered design & delivery• Programme communication• Management & incentives• Production & distribution• Research & innovation

IF : 4THE RETURN ON INVESTMENT

Investment framework projections for new HIV infections

Optimized investment will lead to rapid declines in new HIV infections in many countries

IF: 5ALLOCATIVE EFFICIENCY

IF : 6SHARED RESPONSIBILITY

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

Cost per patient per year (weighted average in US$)

2010 20152020

Lab (new patients) 180 129 79

Lab (cont patients) 180 128 76

Service delivery 176 144 112

1st Line ARVs 155 147 57

2nd Line ARVs 1678 984295

Critical enablers and development synergies: • are necessary but not sufficient by themselves for

effective AIDS responses, by supporting basic programme activities

• encourage sustainability of AIDS responses through integration into other non-health sectors

• are determined and prioritized by country contexts,

• require mechanisms for multi-sectoral financing and governance

HIV-specific(sole/primary objective is an HIV outcome)

HIV-sensitive(HIV outcome is one of many objectives)

Critical enablers

Development synergies

Synergies and enablers – distinct, but overlapping

• Little information on cost

• Country reviews (USD 1 to 14 per adult population)

• Community Health Workers (@ USD 2 per adult population)

Community Mobilization

Community mobilization assumptions in the investment framework Cost envelope: community mobilisation component of the

critical enablers

2011 $0.3bn 2015 $0.6 bn 2020 $1.0 bn

Assumptions:• Increased community capacity • increased community service delivery • need for remuneration of community and lay workers • need for training, guidance, supervision• participation of people living with HIV

Community mobilization: makes scale up possible

• Number of people tested through community mobilization 2010: 46 million (VCT) 2015: 109 million

• Service delivery costs (treatment) 2010: $179 per year 2020: $125 per year ($17 in low income countries)

• Driving costs down: fewer outpatient visits, community support service modalities

• Better Health Outcomes

Community mobilization: increases effectiveness• Community mobilisation increased HIV testing rates four-

fold in Tanzania, Zimbabwe, South Africa and Thailand. • Consistent condom use in past 12 months 4 times higher in

communities with good community engagement (Kenya) • Hypothetical circumcision model KwaZulu-Natal :

– core intervention: 240,000 infections averted over ten years– with enablers: 420,000 infections averted, with modest marginal

increase in costs