DPG-AIDS Welcome

Michelle Roland, LeadOn behalf of DPG-AIDS

Ending AIDS Scenario: New HIV Infections

Total number of people living with HIV/AIDS (PLWHA)

$8B in additional Treatment cost/year

$31B in additional Treatment cost/year

Higher Prevalence in Women: Transition to Adulthood

Age

Perc

ent H

IV p

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HIV Prevalence Changes in Mainland, age 15-49Down for Men but not Women

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0%

1000%

2000%

3000%

4000%

5000%

6000%

7000%

8000%

9000%

10000%

All ages

Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting.

ART GAP BETWEEN ADULTS AND CHILDREN BY COUNTRYPercentage of ART coverage among eligible adults (aged 15+), children (aged 0-14) and all ages in the 21 African Global Plan priority countries, 2012

Children (0-14) living with HIV

(2011)

0 – 20,000

230,001 – 460,000

20,001 – 170,000

170,001 – 230,000

Countries in Africa with largest number of HIV-infected children

Country # of infected children

South Africa 460,000

Nigeria 440,000

Tanzania 230,000

Kenya 220,000

Mozambique 200,000

Zimbabwe 200,000

Top Six Countries

Source: UNAIDS estimates, 2011 and 2012

Estimated 3 Million HIV Positive Children Globally

Pediatric TreatmentUntreated, 50% of HIV-positive children will die before age 2. ART =

HIV Prevalence in Key Populations

Mainland Zanzibar

(ZACP, 2007) (ZACP, 2011)

FSW 31.4 (NACP, 2010)

10.8 20.5

PWID 42 (MUHAS, 2009)

16 11.3

MSM 30*(UDSM, 2012)

12.3 2.6*

NACP = National AIDS Control Programme, MUHAS = Muhimbili University of Health and Allied Sciences, UDSM = University of Dar es Salaam, ZACP = Zanzibar AIDS Control Programme

* Preliminary

Coverage Targets for Full Scale-Up

Current Coverage

Target (2018)

HCT 27% 36%

Condoms 44% 90%

Current Coverage

Target (2018)

Sex workers 5% 80%

MSM 40% 80%

PWID 20% 50%

PMTCT 69% 100%

ART 69% of <350 95% of <500

GOALS Model

Funding Sources

• PEPFAR– COP13 = $347M– COP14 = $375M (submitted)

• Global Fund– $384 M ($191M new)

• 2014 - 2016

• NMSF Grant pool-funded– Canada DFATD : $45M CAD

• 2011-2016

– DANIDA: $39M• 2011-2014

– No secure funding post-2016

• UN – ~ $9M

• Health Basket Fund– New MOU post-2015 under

development– Decreased funding trend

• AIDS Trust Fund– TBD

• Health and HIV/AIDS sectors as a share of total GoT budget continue to diminish – This trend is not sustainable

Within and Above Allocation RequestsModule Allocation ($) Allocation % Above Allocation ($) Full Request ($)

Prev-Gen Pop $9,214,804 4% $8,000,000 $17,214,804

Prev-MSM/TG $1,100,000 0.5% $840,000 $1,940,000

Prev-SW $3,400,000 1% $1,800,000 $5,200,000

PMTCT $34,091,611 15% $34,124,980 $68,216,591

HIV C&T $144,407,162 63% $204,712,793 $248,119,954

TB C&T $15,555,284 7% $9,151,800 $20,040,931

TB/HIV $2,959,231 1% $3,998,152 $6,105,376

MDR-TB $4,287,918 2% $6,318,381 $8,797,952

PSM $2,248,893 1% $1,540,000 $3,788,893

HMIS/M&E $5,032,057 2% $15,252,950 $20,285,008

CSS $1,900,000 1% $1,554,000 $3,454,000

Program Mgmt $5,351,553 2% $0 $5,351,553

Total $229,548,513 $287,293,056 (> 50%)

$516,841,568

ART/Commodity Funding Gap

• Above Allocation request for key commodities: $193,117,348

– Includes ARVs, RTKs, HEID, and lab reagents for HIV testing

Focusing on the Right Things

Core Activities to Maximize Epidemic Impact

• Combination Prevention (PMTCT, ART, Condoms, VMMC)

• Effective/targeted other prevention interventions• Holistic services for families including OVCs• Strengthening Health Systems as specifically

required to support the core activities – Human resources for health, financing, procurement &

supply chain, lab, and strategic information

• Appropriate resources for disproportionately effected, neglected & hard to reach populations

– Young women and children– Key populations – MSM, FSW, PWID

Tanzania-Specific Priorities

• Petty Corruption– BRN - 40% of commodities get stolen – JAHSR there was a presentation by SIKIKA and IHI on petty

corruption at health facilities level

• MSD debt affects its capacity to deliver on its mandate

• Tanzania only has 44% of the required health workers (56% deficit)

Focusing Programs in the Right Places

• Symmetric geographic alignment of program investment and epidemiology

• Saturate the highest burden areas (regions, districts, hotspots) based on

–prevalence & number of PLHIV – greatest unmet need for services

o Among general population/specific neglected populations

• Zero and very low volume facilities – Discontinue (HTC) or maintain but don’t scale up

(treatment and PMTCT) in order to prioritize support to facilities seeing the most clients and communities with greatest need

Measuring Program Efficiency: All HTCPreliminary Analysis Undergoing Review and Revisions

No-yield Low-yield High-yield0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

28%

50%

22%

6%

25%

69%

0%

12%

88%

Percent of total sites (N=8,667)Percent of total tests (N=2,939,835)Percent of total positives (N=137,605)

Modeling Analysis of Investment Options for HIV Program in Tanzania: Optimal Scenario

• The Optimal scenario is designed to maximize impact within a resource constraint of no more than $600 million per year by 2017– It fully scales up the most cost-effective

interventions: ART, PMTCT, FSW, condoms, VMMC– It reduces coverage by ½ to ¾ for the least cost-

effective interventions: mass media, workplace, community mobilization

Futures Institute, Johns Hopkins School of Public Health, UNAIDS, TACAIDS

Scenario Infections Averted(2014-2030)Co

NMSF 1.2 M

PMTCT 0.2 M

ART 0.7 M

Strategic 0.9M

FSW mod 0.1 M

FSW opt 0.2 M

Optimal 0.9M

Scenario Resources Needed (Billions of US$)(2014-2030)

Base $11.4

NMSF $18.7

PMTCT $11.7

ART $13.9

Strategic $14.5

FSW mod

$11.6

FSW opt $11.7

Optimal $12.4

Cost-Effectiveness by Scenario (2014-2030)

NMSF PMTCT ART Strategic FSW Em Mod FSW Em Opt Optimal$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

Cost per Infection Averted

Summary

• Resource needs for full scale up would be 150% higher by 2030.

• A focus on the most cost-effective interventions could achieve 80% of the impact with 75% of the resources

• If resources are constrained to increase at about 4% per year– achieve nearly 80% of the impact – only with re-allocating resources away from less cost-

effective intervention to the most cost-effective ones

Maximising the effect of combination HIV preventionthrough prioritisation of the people and places in

greatest need: a modelling study

TOGETHER, STRATEGICALLY, WE CAN CONTROL THIS EPIDEMIC

Thank you!