hiv/aids challenges and opportunities in the midst of gf funding shortfall gfan meeting 8-10 feb...
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![Page 1: HIV/AIDS Challenges and opportunities in the midst of GF funding shortfall GFAN meeting 8-10 Feb 2012, Amsterdam Kerstin Åkerfeldt & Sharonann Lynch, MSF](https://reader030.vdocument.in/reader030/viewer/2022032804/56649e575503460f94b501e2/html5/thumbnails/1.jpg)
HIV/AIDS Challenges and opportunities in the midst of
GF funding shortfall
GFAN meeting 8-10 Feb 2012, Amsterdam
Kerstin Åkerfeldt & Sharonann Lynch, MSF
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Have to get ahead of the wave...
• Will be condemned
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USD
(Bill
ions
)
Business as usual
Investment framework
- 2.5- 2.0- 1.5- 1.0- 0.5- 0 N
ew H
IV In
fecti
ons
(mill
ions
)
Strategic Investment Framework
Costs/returns
Total additional investment (over 10 years)
US$46.5 Billion
Future treatment need averted
US$40 Billion
2011- 2020 Outcomes (millons)
Total infections averted > 12
Infant infections averted 1.9
Deaths averted 7.4
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Newly eligible for treatment
Newly infected
For every 1000 patient-years on ART
PEPFAR
Deaths averted 228
Children not orphaned 449
Sexual transmission of HIV averted
61
Vertical infections averted 26
TB cases averted among HIV+
9
Life-years gained 2,200
60 – 90 infec av. / 1000 ART initiation in first year is reasonable ‘rule of thumb’.
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6
Accelerated Scale-Up Results in Annual Decline in New HIV Infections in Kenya (CDC)
Under the base-case scenario, incident HIV infections remain relatively constant at or above 120,000 new cases per year. With accelerated treatment scale-up, incident HIV infections could be driven down to ~86,500 by 2015.
Results in Kenya• 93 infections averted for every additional 1000 py on ART• 31% (n 33K) reduction in HIV incidence in 5 years• 59% treatment costs offset through savings (hospitalisations, orphanhood) within 5 years
“Accelerated treatment”• CD4< 500 (among pre-ART)• Discordancy• Pregnancy• HIV/TB co-infection
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Challenges
Feasibility: Massively scaling up testing & ART while plugging the leaky cascade
Affordability: Triple people on ART without tripling the cost
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THE CASCADE
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What can help: tools, strategies, policies
• Increased testing– HBCT: 500K participants, 83% offered said yes; 99% of people received their result
• Increased coverage & higher CD4 count threshold• Decentralization & patient self-management
– Adherence clubs in Khayelithsa: 97.5% RIC at 2 years– Community ART groups in Mozambique: 98% RIC at 2 years
• Viral load• Pts 58% less likely to die in countries where routine VL available; 53% less likely to be LTF• Adherence trigger: 76% UDL
• Xpert• Optimization of ART:
– More patient-friendly: fewer pills– More potent– More tolerable
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Momentum• 15 x 15• Sec Clinton: priority
interventions can end AIDS
• Pres Obama: 2m on ART, 1.5m PMTCT over 2 years
• 5 countries in negotiation to support “accelerated treatment”
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The impact of Round 11 cancellation
• No new funds for scale up before 2014 (2 years gap) => scale up depending on funds in ongoing grants (phase 2 pipeline)
• Countries’ R11 preparatory work interrupted – impact on motivation at country level?
• Transititional funding mechanism (TFM) – only for continuation of essential services => vague defintions and confusion at country level
• Limited country impact assessment so far… (IAA released, MSF:ongoing - UNAIDS, GF, others?)
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Foreseen impact on programmes R11 cancellation cont.
1. Treatment scale up plans being revised/delayed (DRC, Myanmar, Guinea)– Caps on number of new initiations due to funding uncertainty (medical
risks) – Risk for loss of benefits for wider health impact, prevention, cost
savings, health systems2. Delayed or rationed implementation of WHO guidelines (Uganda, Malawi,
Moz)– Excluded from good practices & promising benefits
(3.) Potential risks for low ARV stock levels or stock outs due to funding shortfall – Depleted buffer stocks– Risk of treatment interruption
(4.) Donors withdrawing from support and counting on GF R11 – now revising these decisions or already exiting?
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Phase 2 renewals and reprogramming – challenges and opportunities
• >8bn to be disbursed in phase 2 renewals (2011-2013)- but available funds far from matching current funding needs in many countries
• Minus efficiency cuts and savings…
• Reprogramming: ”facilitate strategic refocusing of existing investments” and ”focus on highest-impact interventions” according to GF strategic objective + UNAIDS investment framework => targeted interventions and increased coverage to reach tipping point where decreased hiv infection rates and mortality reduces costs
or
• Full effect undermined due to filling gaps created by Round 11 cancellation?
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Advocacy messages• The funding crisis threatens the progress achieved. With new research,
tools and innovative approaches coming on line this is not the time to reduce international efforts.
• In many countries, the lives of patients on ART and those still waiting for treatment depend on increased and continued financial support of donors through the GF.
• Strategically focusing on high impact interventions, by using existing funding (phase 2 renewals) must move forward to maximise impact, but will not be sufficient to reach the needed level of scale up.
• It is unacceptable that there will be no new GF funding for scale-up of HIV services until 2014.
• GF caretakers and especially its donors, must ensure the GF is open for business and can ensure countries can apply for new funding by mid-2012 and hold an emergency donor conference to raise the resources needed.