pepfar scenario –based cost projections for pepfar resource requirements for the art program in...
TRANSCRIPT
PEPFAR
Scenario –based Cost Projections for PEPFAR Resource Requirements for the ART Program
in Ethiopia from FY2011 – FY2015
Solomon Ahmed, M.D.Technical Officer-Treatment
Centers for Disease Control and Prevention-Ethiopia
AIDS 2012 - Turning the Tide Together
Background-Ethiopia
Total Population – 80 million+HIV prevalence* – 2.4% ART eligible – 397,818 (26,053 < 15 years)Currently on ART March 2012** – 257,000+
* 1.5% from the 2011 DHS results. ** PEPFAR Ethiopia SAPRhttp://www.smartraveller.gov.au/zwiki/pub/Maps/countries/dfat/Ethiopia.jpg http://mapsof.net/uploads/static-maps/where_is_ethiopia_located.png
2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 -
100,000
200,000
300,000
400,000
500,000
600,000
700,000
39,489
164,560
266,507
376,772
473,772 580,919
24,236
97,299
150,136
208,784
268,934
333,434
18,594
73,124 109,930
152,472
207,733 247,805
EVER ENROLLED TO CARE EVER STARTED ON ART CURRENTLY RECEIVING ART700,000
600,000
500,000
400,000
300,000
200,000
100,000
Background - EthiopiaN
umbe
r of P
LHIV
Trends in no. of PLHIV enrolled to care and ART in Ethiopia from 2005 - 2011
YearHSDP IV Annual Performance Report EFY 2003 (2010/11)
Activities supported for site level services
PEPFAR Global Fund Government of Ethiopia
Site support (mentoring, supervision, supplies, equipment, renovation)In-service trainingLab monitoringM & ESupport staff
Procurement of ARV drugs and OI drugs
InfrastructureClinical staff
Objective of study
Provide PEPFAR-Ethiopia with funding projections for different scenarios of scale-up
Methods
Utilized results from FY 2010 expenditure analysis to calculate unit costs
Used the PEPFAR ART Costing model 2010 Developed different scenarios based on rates
of enrollment of new patients
Service delivery supportProcurement cost of ARVs (contingency), lab
reagents, and other commodities Technical support and managerial overheads
provided by PEPFAR-funded implementing partners
PEPFAR expenditures included
PEPFAR expenditures excluded
Managerial overheads incurred within USG government agencies
Costs of related services from other program areas (HIV testing, PMTCT, community-based care)
Scale-up Scenarios used for cost projections
Scenario Description1 Current pace of new patient enrollment –
4000/month
2 50 % reduction in ART enrollment to 2000/month
3 Slow linear scale-up to universal access targets (achieving universal access targets by the end of the fourth year)
4 Rapid scale-up to universal access targets (achieving universal access targets by the end of the first year)
Assumptions
Number of pre-ART patients grows proportional to the number of ART patients
Pediatric ART proportion increases from 5.9% to 9.0% of total on ART by the end of FY2015
Patients on 2nd line regimens increase from 0.6% to 4.8% of total on ART by the end of FY2015
Estimated unit cost for ART and pre-ART patients
Average annual per patient costs of $202 for ART patients and $94 for pre-ART patients
Per patient costs expected to be relatively flat over the period of projection
ART program scale-up trends in alternate scenarios
Start of 2011
End of 2011
End of 2012
End of 2013
End of 2014
End of 2015
0
100,000
200,000
300,000
400,000
500,000
600,000
Scale up 4,000 Per Month
Scale-up 2,000 Per Month
Slow Scale-Up to Universal Access Targets
Rapid Scale-Up to Uni-versal Access Targets
Current pace
No.
of A
RT p
atien
ts
600,000
500,000
400,000
300,000
200,000
100,000
Comparisons of trends in projected costs under different scenarios FY 2011 - 2015
FY 2011 FY 2012 FY 2013 FY 2014 FY 20150tan28a566028
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Scale up 4,000 Per Month (base case)Scale-up 2,000 Per MonthSlow Scale-Up to Universal Access TargetsRapid Scale-Up to Universal Access TargetsIn
mill
ions
USD
$344.3 M
$449.3 M
$506.3 M$564.8 M
Conclusions
Cost projections facilitate informed planningProjections offer options of ART scale-upCurrent trend in patient uptake in Ethiopia fall
short of attaining Universal Access by 2015
Acknowledgments
Nick Menzies – ICF MACRO Thomas Kenyon – CDC EthiopiaZenebe Melaku – CU ICAPTsigereda Gadisa – CU ICAP Bill Graham – UW ITECHGetachew Feleke – UW ITECHSolomon Zewdu – JHU
Misrak Makonnen – CRS/AIDSRelief Diana Mattanovich – UCSDYoseph Mamo –UCSDThomas Heller – CDC EthiopiaCate McKinney – CDC EthiopiaAbubaker Bedri – CDC EthiopiaAll CDC Ethiopia technical staff