The Impact and Cost of the HIV/AIDS Investment Framework for Adolescents
John Stover1, Jim Rosen1, Susan Kasedde2, Priscilla Idele2, Craig McClure2
1Futures Institute, 2UNICEF
Source: Schwartlander, Stover et al 2011, Towards an improved investment approach for an effective response to HIV/AIDS, Lancet; 377: 2031–41.
4
Impact of Investment Framework
5
Estimated Cost of Investment Framework, 2011-2020
6
Purpose: Focus on Adolescents
Apply the Investment Framework analysis to adolescents to determine: Impact of investing in prevention for
adolescents 10-19 on new infections, number of HIV+ adolescents, and adolescent AIDS deaths
Cost of programs by type Number of adolescents needed to be
reached by type of service
7
Population of Developing Countries by Age (Millions), 2012
0-4
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80+
-400
,000
,000
-200
,000
,000 0
200,
000,
000
400,
000,
000
Males Fe-males
Pop 10-19 = 19% of total population, 26% of adult population, 17% of sexually active population
8
Scenarios Base
Constant coverage for prevention and treatment Investment Framework (IF)
Coverage scales up to target levels by 2015 Investment Framework Delayed (IF Delayed)
Coverage targets not achieved until 2020 Pessimistic
Lower coverage targets Targets achieved in 2020 Low values of intervention impact
Goals Model
Pop GroupLow RiskMed RiskHigh Risk
MSMIDU
Behavior
Type of Transmissio
nSex
NeedleBloodMTCT
Probability of
Transmission
New HIV Infections
Behavior Change
• Outreach• Education• Communication
Technology•Condoms
•STI Tx•MC•PrEP
•Microbicdes•Vaccines
CoverageEffectiveness
Treatment
10
Methods: Impact Goals model in
Spectrum applied to 28 countries
Results scaled-up to all 120 low and middle income countries
11
Adolescent Percent of Target Population
PMTC
T
Condo
ms
VMMC
Key Po
psC&T
BCCART
Scho
ol
STI T
X
Fam
ily p
lann
ign
OVCs0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12
Estimating the Adolescent Markup
Program ElementsService Delivery System Support
Intervention Drugs / Supplies Labor
Equip-ment IEC Training
Super-vision Logistics Mgmt.
Infra-structur
e M&E
Markup
Score
PMTCT 1.75
Screening + + 2
Family Planning + + + + + + 6
CD4 Testing 0Prophylaxis for HIV infected pregnant women
Option A + + 2
Option B + + 2ART for mothers who need it for their own health + + 2
Early infant diagnosis 0
Cotrimoxazole Prophylaxis 0
Estimating Adolescent Unit Costs
Category Investment Framework Unit Costs
Adolescent
Markup
% Markup
Basic Programs
-PMTCT $300 - $1000 / HIV+ woman Medium 40%
-Condoms $0.08 - $0.27 / condom distributed Low 25%
-Male circumcision $40 - $100 / circumcision Medium 40%
-Key populations (FSW, MSM, IDU)
$20 - $40 /person reached$1000 - $2000 / drug substitution
L/M/H 25/40/50%
-Behavior change $5 - $18 / person reached None 0
-ART $360-$600 / person treated Medium 40%
Critical Enablers
-HIV C&T $1 - $12 - $20 / person tested Medium 40%
-Community mobilization $1 - $3 / person reached High 50%
-Mass media $300,000 - $3M / campaign None 0
Development Synergies
-School-based programs $40 - $200 / teacher trained None 0
-STI treatment $20 - $50 / case treated Medium 40%
-Family planning $8 - $20 / modern method user
High 50%
14
New HIV Infections Among Adolescents
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
BaseIFIF DelayedPessimistic
15
New HIV Infections by Sex (10-19)
2010
2012
2014
2016
2018
2020
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
Female: BaseFemale: IFFemale: IFDFemale: Pess.Male: BaseMale: IFMale: IFDMale: Pess.
16
AIDS Deaths Among Adolescents
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020105,000
110,000
115,000
120,000
125,000
130,000
135,000
IFIF DelayedPessimisticBase
17
HIV+ Population (10-19): Investment Framework
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
Male 15-19Male 10-14Female 15-19Female 10-14
18
Estimated Resource Needs for Adolescents
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020$0
$1,000,000,000
$2,000,000,000
$3,000,000,000
$4,000,000,000
$5,000,000,000
$6,000,000,000
$7,000,000,000
Basi
c Pro
gra
ms
Cri
tica
l
En
ab
lers
Develo
pm
ent
Syn
erg
ies
19
Estimated Resource Needs for Adolescents
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020$0
$1,000,000,000
$2,000,000,000
$3,000,000,000
$4,000,000,000
$5,000,000,000
$6,000,000,000
$7,000,000,000 OVC
UP
Safe Injection
PEP
Blood safety
STIs
Prisoners
PVAW
Family Planning
Education
International
Logistics
Communica-tions
M&E
Research
Management
Human Rights
Legal
Advocacy
Mass media
Com. Mob.
VCT
BCC
MC
PITC
ART
IDU
MSM
FSW
Condoms
PMTCT
Basi
c Pro
gra
ms
Cri
tica
l
En
ab
lers
Develo
pm
ent
Syn
erg
ies
Largest amounts needed for OVC (20%); ART (9%); STI management (7%); and community mobilization, prevention of gender-based violence and PWID (6% each)
20
Putting Adolescents in Perspective
Adolescents
26%
Resource Needs for Adolescent Response in 2015
21
Conclusions Impact
The IF could avert 1.5 million new adolescent infections by 2020
31% of the total new infections to adolescents under the Base Scenario
A five year delay would reduce impact by 1/3 Poor implementation would result in little decline in
the annual number of new infections Resources for adolescents
Need to expand by 50% to nearly $6 billion by 2015 to achieve goals of Investment Framework
After 2015 needs will decline somewhat due to reductions in new infections
1/3 of needs are for Basic Programs, ¼ for Critical Enablers, 40% for Development Synergies