Moving to the final chapter of the AIDS epidemic.

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Presentation transcript:

Moving to the final chapter of the AIDS epidemic

The agreed target are about to expire…

Treatment continues to expand

Treatment continues to expand

UNAIDS PCB calls for new targets Targets drive progress New scientific evidence Post 2015 Accountability A winnable challenge

The choices Status quo Continue the current pace WHO 2013 guidelines Rapid scale-up to universal access

The treatment target

The new treatment paradigm Single target → Cascade target Death → Death and transmission Number → Equity Incremental funding→ Frontload Investments

90% of HIV+ people tested is possible

Source: Demographic and Health Surveys Men Women HIV+ population tested at least once

Access To Virologic HIV Testing (Early Infant Diagnosis) 2012 *Lesotho data represents 2011 coverage data Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting, and UNAIDS modeling2012 HIV and AIDS estimates.

90% of eligible people on treatment is possible

high coverage in several countries Brazil UNGASS Country Progress Report (2012) UNAIDS Situation Room

90% virally suppressed is possible

Proportion (95% CI) of patients with undetectable VL in a nationally representative sample of HIV-infected adults on ART in Rwanda Source: Basinga P et al. (2013) PLoS Site S Site T Total % 80.00% 60.00% 40.00% 20.00% Site A Site B Site C Site D Site E Site F Site G Site H Site I Site J Site K Site L Site M Site N Site O Site P Site Q Site R 83%

Preparedness is key

Challenges ahead: 1- Societal Lack of knowledge of HIV status Punitive policies and laws Stigma and discrimination

Challenges ahead: 2- delivery systems Source: Location, Location: Connecting people faster to HIV services, UNAIDS; Geneva, 2013 Relative likelihood of HIV-positive adults (15-49 years) accessing antiretroviral therapy due to the distance from their nearest primary healthcare facility.

Uptake of pediatric HIV services after introduction of family-based approach Luyirika et al. PLoS ONE, 2013

Cost of treatment per ART patient year by country US Dollars Challenges ahead: 3- diverse facility level costs *Republic of South Africa: costs include updated antiretroviral prices, which were renegotiated by the RSA government in early 2010 and are 53% lower than those observed during the costing period. US$ Average Maximum Minimum US$136 US$186 US$232 US$278 US$682 South Africa*

Challenges ahead: 4- treatment cascade Sources: 1. UNAIDS 2012 estimates; 2. Demographic and Health Surveys, 2007–2011 ( 3. Kranzer, K., van Schaik, N., et al. (2011), PLoS ONE; 4. GARPR 2012; 5. Barth R E, van der Loeff MR, et al. (2010), Lancet Infect Disease. Notes: No systematic data are available for the proportion of people living with HIV who are linked to care, although this is a vital step to ensuring viral suppression in the community.

Challenges ahead: 5- Financing Malawi Lesotho Zimbabwe Mozambique Burundi Uganda Central African Rep. Tanzania Zambia Swaziland Kenya Liberia Togo Rwanda Sierra Leone Cameroon Chad Guinea-Bissau Côte d’Ivoire Botswana Haiti Guinea Namibia Djibouti Nigeria South Africa Burkina Faso Niger Benin Eritrea Ghana Mali Cambodia Belize Myanmar Senegal ART costs as a percentage of GDP % 2% – 5% 5% – 8% 0.1% – 1% 1% – 2% Source: Williams arXiv 2012: