This document presents projections for antiretroviral (ARV) drug demand and usage in low and middle income countries from 2014-2025. It shows trends in the number of people accessing treatment and compares projections from different scenarios. It also provides forecasts for the market share and uptake of various first-line, second-line, and salvage regimen drugs over time, concluding that production of current ARVs needs to continue to ensure availability until more data is available on newer drugs.

1. 11 August 20151 |
Forecasted demand for current
and new ARV medicines in low
and middle income countries,
2014-2025
J Perriëns (WHO), S Juneja (MPP) and V Prabhu (CHAI) on behalf of the
WHO ARV Forecasting Technical Working Group
(Avenir Health, CDC, CHAI, GFATM, MPP, PfSCM, UNAIDS, UNICEF, USAID, WHO)

2. 11 August 20152 |
Observed trends and projected number of people on ART according to Linear, Fast
Track, Country Target Projections, and Average of 4 Projections
8.02
9.7
11.7
30.7
19.7
23.5
0
5
10
15
20
25
30
35
2011 2012 2013 2014 2015 2016 2017 2018
Million people on ART
Observed trend Linear Fast Track Country targets CHAI Average

3. 11 August 20153 |
Millions of Adults Treated in MPP and CHAI scenarios
24.1
20.1
0.0
5.0
10.0
15.0
20.0
25.0
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Millions
MPP = FT First line
MPP Second line
MPP Salvage
MPP = FT Total
CHAI First Line
CHAI Second Line
CHAI Total
First Line
Total

4. 11 August 20154 |
Uptake curves
WHO/MPP CHAI
0%
20%
40%
60%
80%
100%
Y0 Y2 Y4 Y6 Y8 Y10
PercentageMarketShare
Years from Introduction
Uptake Curves for new products
Aggressive
Baseline
Conservative
0%
20%
40%
60%
80%
100%
Y0 Y2 Y4 Y6 Y8 Y10
PercentageMarketShare
Years from introduction
Uptake Curve for new products
Aggressive switch
scenario
(hypothetical)
Conservative
switch scenario:
Historical ATV/r
share (2L pts)
Moderate switch
scenario:
Historical TDF
share (all ART
pts)

5. 11 August 20155 |
Drugs included
Companion:
EFV, NVP
DTG
LPV/r
ATV/r
DRV/r
Backbone:
TDF+ XTC
TAF+ XTC
ZDV+XTC
DTG

6. 11 August 20156 |
TDF+XTC % market share in backbone of
treatment regimens
27%
53%
62%
67%
71% 71%
20%
30%
40%
50%
60%
70%
80%
2011 2012 2013 2014 2015 2016 2017 2018
Survey CHAI GPRM SCMS GF Average
DATA PROJECTION

7. 11 August 20157 |
Percent of people on first line treatment taking
TAF, TDF and ZDV
32%
23%
15%
8%
1% 0%
62%
63%
66%
55%
44%
29%
13%
31%
49%
65%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MPP-WHO
AZT TDF TAF
31% 26% 25% 25% 25% 25%
69% 74%
56%
22%
8% 4%
19%
53%
67% 71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CHAI
AZT TDF TAF

8. 11 August 20158 |
Percent of people on first-line treatment taking
DTG vs. EFV vs. NVP
MPP-WHO CHAI
36%
25%
16%
8%
1% 1%
63%
66%
59%
49%
40%
22%
8%
24%
42%
58%
76%
0%
20%
40%
60%
80%
100%
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
NVP EFV DTG
38%
28%
18%
10% 6% 5%
62%
53%
29%
11%
7% 5%
6%
17%
19%
19%
19%
12%
36%
59%
68% 72%
0%
20%
40%
60%
80%
100%
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
NVP EFV 600 EFV 400 DTG

9. 11 August 20159 |
DTG, AZT, TDF, and TAF/XTC
in backbone of second-line treatment
31% 32% 30%
44%
38%
29%
61% 57%
43%
21%
16%
12%
5%
10%
16%
23%
33%
4%
10% 12% 15% 17%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
MPP-WHO
AZT TDF TAF DTG
46% 42%
18%
6% 3% 3%
54%
39%
25%
15%
12% 11%
19%
57%
79%
85% 87%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
CHAI
AZT TDF DTG

10. 11 August 201510 |
Protease inhibitors and DTG
as companion drugs in second-line treatment
75%
66%
45%
17% 17% 17%
23%
24%
27%
50%
38%
25%
2%
6%
11%
15%
8%
24% 25%
33%
42%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MPP-WHO
LPV/r ATV/b DRV/b DTG
72%
60%
53% 49%
40%
33%
28%
40%
43%
41%
32%
27%
3%
10%
28%
41%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CHAI
LPV/r ATV/r DRV/r
Note: DRV/r uptake highly dependent on reaching “at-scale” pricing
parity with LPV/r, and likely cost offsets for (re)launch prices

11. 11 August 201511 |
Main products used in salvage treatment
DRV
RALETV
Others
Usage in Resistant Patients: 2015
N = 25.900
DRV
RAL
DTG
ETV
Others
Usage in Resistant Patients: 2025
N = 506.700

12. 11 August 201512 |
9.8
4.8 5.1
8.9
0.4 0.1
8.8
3.9
5
8.1
0.4 0.2
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
TAF TDF AZT NVP EFV LPV ATV DRV DTG RAL
ARV use in 2015 - Million People by
Active Ingredient
2015 MPP/WHO 2015 CHAI

13. 11 August 201513 |
5.1
13.5
2.6 2.2
11.0
0.9 1.1
0.3
7.9
0.2
5.1
7.7
4.3
2.4
6.6
0.5 0.4 0.1
9.1
<0.1
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
TAF TDF AZT NVP EFV LPV ATV DRV DTG RAL
ARV use in 2020 - Million People
by Active Ingredient
2020 MPP/WHO 2020 CHAI Note: EFV includes both 600mg and 400mg formulations

14. 11 August 201514 |
13.5
5.9
1.9
0.6
4.1
0.5 0.7 0.7
17.6
0.1
13.3
0.7
4.7
0.9
4.5
0.3 0.3 0.4
14.6
<0.1
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
TAF TDF AZT NVP EFV LPV ATV DRV DTG RAL
ARV use in 2025 - Million People by Active Ingredient
2025 MPP/WHO 2025 CHAI Note: EFV includes both 600mg and 400mg formulations

15. 11 August 201515 |
Conclusion
 Our forecasts include a mix of
judgement and data
 Areas of convergence are
useful to inform action
 Until more data become
available, production of the
current generation of ARVs
needs to continue, and
increase, to ensure that all
necessary drugs will remain
available.