hiv therapy for the developing world: a global health challenge harold w. jaffe, md department of...
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HIV Therapy for the Developing World: A Global Health Challenge
Harold W. Jaffe, MD
Department of Public Health
University of Oxford
Oxford, UK
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Adults and children estimated to be living with HIV 2006
Total: 39.5 (34.1- 47.1) million
Western & Central Europe
740,000740,000
North Africa & Middle East
460,000460,000
Sub-Saharan Africa24.7 million
Eastern Europe & Central Asia
1.7 million 1.7 million
South & South-East Asia
7.8 million7.8 millionOceania81,00081,000
North America1.4 million
Caribbean250,000250,000
Latin America1.7 million
East Asia750,000
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Estimated adult and child deaths from AIDS2006
Total: 2.9 (2.5 – 3.5) million
Western & Central Europe
12,00012,000
North Africa & Middle East
36,00036,000
Sub-Saharan Africa2.1 million2.1 million
Eastern Europe & Central Asia
84,000 84,000
South & South-East Asia
590,000Oceania
4,0004,000
North America18,00018,000
Caribbean19,00019,000
Latin America65,00065,000
East Asia43,00043,000
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HIV prevalence (%) in adults in Africa, 2005HIV prevalence (%) in adults in Africa, 2005
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Impact of AIDS on life expectancy in five African Impact of AIDS on life expectancy in five African countries, 1970–2010countries, 1970–2010
Life expectancy at birth (years)
Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database.
Botswana
South Africa
Swaziland
Zambia
Zimbabwe
1970–1975 1975–1980
1980–19851985–1990
1990–19951995–2000
2000–20052005–2010
70
65
60
55
50
45
40
35
30
25
20
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Estimated Annual GDP Loss Attributed to HIV/AIDS, 1992-2002
Country Loss in US$ (millions)Botswana 270South Africa 7,230Swaziland 102Zambia 127
Zimbabwe 638
International Labour Organisation, United Nations: HIV and Work: Global estimates, impact and response, 2004
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Mortality and HAART Use Over TimeHIV Outpatient Study, CDC, 1994-2003
0
2
4
68
10
12
14
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
Dea
ths
per
100
PY
00.10.20.30.40.50.60.70.80.9
Pat
ient
s on
HA
AR
T
Patients on HAART
Deaths per 100 PY
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Daily Cost of Antiretroviral Drugs 3TC/d4T/Nevirapine
Source Cost
U.S. retail pharmacy1 $39
Low-income countries
(average)2
$00.34
1The Medical Letter 2006;4:67 2UNAIDS, April 2007
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The President’s Emergency Plan for AIDS Relief
• Announced January 28, 2003
• 15 focus countries
• Goals:
− Treat 2 million HIV-infected people
− Prevent 7 million new HIV infections
− Provide care for 10 million HIV-infected people and AIDS orphans
Overall budget for global AIDS: $15 billion over 5 years ($10 billion new money)
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ARV Therapy in Low and Middle Income Countries: December 2006
0
1
2
3
4
5
6
7
Sub-SaharanAfrica
Latin America andthe Caribbean
East, South andSouth-East Asia
Europe andCentral Asia
North Africa andthe Middle East
(Nu
mb
er
of p
eo
ple
in
mill
ion
s)
Unmet need
Receiving ARV therapy
68% of the total unmet need
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Challenges in Implementing ARV Programs in Developing Countries
• Lack of knowledge of HIV infection status
• Need for new care models
• Lack of trained personnel
• Laboratory support
• Corruption/maintenance of supply chain
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The Global Challenge of HIV/AIDSUnanswered Questions in the ARV era
• Can a prevention focus be maintained?
• What happens when ARV resistance emerges?
• Can ARV programs upgrade medical infrastructure?
• Will staff and resources be diverted from other critical programs?
• Can ARV programs be sustained?
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Estimated total annual resources available for AIDS,
1996–2005
PEPFAR
Source: Lancet, 2006; 368: 526–30
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
9 000
8 000
7 000
6 000
5 000
4 000
3 000
2 000
1 000
World Bank MAP Launch Signing of Declaration of
Commitment on HIV/AIDS
Global Fund
( U
S$ m
illio
ns
)