Funding Mechanisms and the End of AIDS

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  • ***HIV testing via CHWs and provider initiated testing*** to implement evolving WHO guidelines towards earlier init***shifting countries to ART for b+, sero-ds, earlier init, and viral load!support lab strengtheningtask shifting including soft stuff on community service delivery models (not explicit ART community groups)decentralization of ART***POC CD4 machines, integration of srh including contraceptives & family planningsupport for recurrent costs including salaries, drugs, lab supplies ***support viral load in several places***require PLHIV consultation as part of the broader civil society engagement that is an explicit component in cops process.small grants for CSOs in demand creation & reducing legal, policy & structural barriers to effective HIV responseensure that key pops are involved in planning & implementation of programmes that affect their lives**expansion of social insurance programmes, esp to cover middle class people **partner w WB to ID ways the bank can support***PEPFAR will work to establish incentives for annual progressive increases in domestic financing
  • ***HIV testing via CHWs and provider initiated testing*** to implement evolving WHO guidelines towards earlier init***shifting countries to ART for b+, sero-ds, earlier init, and viral load!support lab strengtheningtask shifting including soft stuff on community service delivery models (not explicit ART community groups)decentralization of ART***POC CD4 machines, integration of srh including contraceptives & family planningsupport for recurrent costs including salaries, drugs, lab supplies ***support viral load in several places***require PLHIV consultation as part of the broader civil society engagement that is an explicit component in cops process.small grants for CSOs in demand creation & reducing legal, policy & structural barriers to effective HIV responseensure that key pops are involved in planning & implementation of programmes that affect their lives**expansion of social insurance programmes, esp to cover middle class people **partner w WB to ID ways the bank can support***PEPFAR will work to establish incentives for annual progressive increases in domestic financing
  • ***HIV testing via CHWs and provider initiated testing*** to implement evolving WHO guidelines towards earlier init***shifting countries to ART for b+, sero-ds, earlier init, and viral load!support lab strengtheningtask shifting including soft stuff on community service delivery models (not explicit ART community groups)decentralization of ART***POC CD4 machines, integration of srh including contraceptives & family planningsupport for recurrent costs including salaries, drugs, lab supplies ***support viral load in several places***require PLHIV consultation as part of the broader civil society engagement that is an explicit component in cops process.small grants for CSOs in demand creation & reducing legal, policy & structural barriers to effective HIV responseensure that key pops are involved in planning & implementation of programmes that affect their lives**expansion of social insurance programmes, esp to cover middle class people **partner w WB to ID ways the bank can support***PEPFAR will work to establish incentives for annual progressive increases in domestic financing
  • Funding Mechanisms and the End of AIDS

    1. 1. Ending AIDS in Kenyanew drugs and faster treatment enrollment will cost effectively break the back of the epidemic.
    2. 2. Rapid Steps to End AIDS in Kenya New evidence has powerfully demonstrated that we can halt new infections.HIV Prevention Trials Network study 052: Tested to see if ART can prevent HIV transmission between couples where one partner is living with HIV; and to determine when to initiate treatment. 1,763 serodiscordant couples at 13 sites in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe. The study arms compared immediate ART initiation at or below 500 CD4 versus delaying till 350 CD4
    3. 3. Rapid Steps to End AIDS in Kenya HPTN 052 results: earlier ART initiation resulted in a reduction in new infections. 27 HIV transmissions occurred in the delayed treatment arm. Only one infection happened in the early treatment arm, and appears to have happened at ART initiation, before ARVs could fully achieve viral suppression. Myron S. Cohen et al, Prevention of HIV-1 Infection with Early Antiretroviral Therapy; N Engl J Med 2011 365:493-505 August 11, 2011
    4. 4. Rapid Steps to End AIDS in Kenya ART broadly benefits all of society --and costs are declining. • For every 1000 patient-years of treatment provided:• 228 people deaths averted• 449 children not orphaned• 61 sexual transmissions of HIV averted• 26 vertical (mother-to-child) infections averted• 9 TB cases averted among HIV patients• 2,200 life-years gained.
    5. 5. Rapid Steps to End AIDS in Kenya Treatment’s Broad Benefits to Society: Cost savings from averted Costs Savings Attributable to ART negative outcomes offset the major portion of total treatment $M180.4 $M280.6 Averted non-ART program costs. treatment costs Averted orphan care • Net estimated societal cost of costs treatment in 2011: $172 per$M574.2 Averted sexual transmissions discounted life-year gained. $M614.9 Averted vertical transmissions Based on WHO standards for cost-effectiveness, ART is highly cost-effective in most of sub- Source: Center for Global Health Division of Global HIV/AIDS Saharan Africa.
    6. 6. Rapid Steps to End AIDS in Kenya AIDS treatment more than pays for itself.Hesch et al. (2011) compared treatment costs of 3.5 million people on ART supported bythe Global Fund against the benefits of restored productivity for people able to workagain, savings in unneeded orphan programmes, and averted costs for TB and other OIs. • The financial saving of keeping these 3.5 million people alive and well would amount to between 85% and 240% of programme costs. 2010 Kenya GDP per capita GDP: US$1,689 (Kshs 139,329) (World Bank PPP data) Net estimated societal cost of treatment in 2011: $172 (Kshs 14,189) per discounted life-year gained. (Center for Global Health, Division of Global HIV/AIDS) • By WHO standards for cost- effectiveness, ART is highly cost-effective in Kenya. Resch S, Korenromp E, Stover J, Blakley M, Krubiner C, et al. 2011 Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries. PLoS ONE 6(10): e25310. doi:10.1371/journal.pone.0025310
    7. 7. But there’s more.
    8. 8. Rapid Steps to End AIDS in Kenya GAME CHANGING NEW DRUGS• TAF – tenofovir pro-drug, just entered phase III trials:• -Studies have shown decreased renal and bone metabolism toxicity as compared to TDF• -Can use 1/10 the mg dose - so potential for lower cost• -May retain activity in the setting of some common TDF mutations.• DTG-finally an integrase inhibitor:• -Most effective ART at bringing down VL rapidly• -Theoretically cheap• -Very potent - people dont fail often and dont fail with mutations• -Once daily• -Increasing evidence for safety in kids
    9. 9. Rapid Steps to End AIDS in Kenya Landmark 052 results are magnified by CDC modeling of accelerating treatment scale up. The current pace of ART scale-up in Kenya will continue to incur rising costs, and is not sufficient to outpace new infections. At the September PEPFAR Scientific Advisory Board, CDC presented a model gauging the impact of accelerating AIDS treatment enrollment in Kenya.
    10. 10. KENYA: With Accelerated Scale-Up, an Additional 323,000 are Moved to Treatment from Current Clinical Care and PMTCT 1,000 Thousands 900 800 700 600 500 400 300 200 100 - 2010 2011 2012 2013 2014 2015 Base Case Accelerated Scale-UpBased on population estimates in the following priority populations: patients already in care with CD4<500, PMTCT patients, HIV patients with active TB, known PLHA in sero-discordant couples 10
    11. 11. Accelerated Scale-Up Results in Annual Decline in New HIV Infections – 31% by 2015 140,000 120,000 100,000 80,000 Accelerated Scale-up Base Case 60,000 40,000 20,000 0 2010 2011 2012 2013 2014 2015Under 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. 11
    12. 12. Under Accelerated ART Enrollment, Significant Savings Result Over Status Quo: $800Millions $700 $600 $500 $400 Accelerated Scale-Up Base Case $300 $200 $100 $0 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020Estimated costs to maintain current coverage levels in the Base Case and Accelerated Scale-Up Scenario. Flattened treatment costs in the accelerated scale-up scenario reflect effects of declining HIV incidence and additional implementation efficiency. 12
    13. 13. Rapid Steps to End AIDS in Kenya Treating more people faster has dramatic benefits. By quickly enrolling PLHIV above current baselines of ART scale-up in Kenya, CDC concluded that, by treating 900,000 by 2015: New infections would decline by 31% by 2015 And costs are reduced below current levels, up to 33%
    14. 14. Rapid Steps to End AIDS in Kenya Treating more people faster is the cheapest option.Net costs=treatment costs minus costs averted:• greatly reduced new infections• medical costs for HIV-related illness and opportunistic infections• orphan care• sustained productivity for workers and families• increasing service delivery efficiencies• shrinking drug unit costs• spill-over health systems benefits and synergies
    15. 15. Rapid Steps to End AIDS in Kenya Kenya and Development Partners Must Update Guidelines and Budget to Accelerate Treatment Scale-up: Treat all serodiscordant couples regardless of CD4 as per new WHO guidelines. Start the wheels in motion for new ARVs now! Lifelong ART for all pregnant/nursing women nationwide—this year!! ART for all active TB patients Earlier Initiation at 500 CD4 Greater use of viral load--comparable costs to CD4!
    16. 16. Rapid Steps to End AIDS in Kenya Kenya and its Development Partners must pay now, or pay more later. Kenya must increase health spending health to comply with PEPFAR Partnership Framework commitments by Treasury to increase domestic health budgets by at least 10% annually from 2010-2013. PEPFAR must sustain it’s funding commitments under the Partnership Framework. We cannot reach six million by 2013 if OGAC breaks PPF commitments to Kenya. Donor countries must increase contributions to the Global Fund. With Round 11 delayed, Kenya should lead other African countries to call for an emergency replenishment conference before the IAS in Washington.
    17. 17. Blueprint for an AIDS- Free Generation:• “UPFRONT costs associated w scaling up combo prevention are substantial, but these investments do not result in ever-increasing costs. in fact, the impact of up-front investments is a decline & then a flattening of out-year costs, as fewer new services are needed and the number of new infections falls substantially.”• “PEPFAR is firmly committed to help countries move beyond the tipping point”
    18. 18. TIPPING POINT: when treatmentoutpaces infections
    19. 19. Blueprint for an AIDS- Free Generation:
    20. 20. Thank You Minister:“To reap the full benefits of this year’s scientific breakthroughs, weshall, together with our development partners, endeavour to put onemillion people with HIV on treatment by the end of 2015, scaling upfrom the current 460,000. This is a challenge that the country iswilling to tackle since its success will reduce the heavy diseaseburden that the country has carried since the emergence of the HIVepidemic. The additional resources Kenya is willing to commit to thefight against HIV and AIDS will result in significant cost-savings later.”“We believe that expanding HIV treatment to reach all Kenyans inneed is one viable way to both break the back of the HIV epidemicand sustainably fund the fight against HIV.” -Hon Minister of Special Programmes Esther Murugi

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