DPG-AIDS Welcome Michelle Roland, Lead On 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 Percent HIV positive

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

Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting. ART GAP BETWEEN ADULTS AND CHILDREN BY COUNTRY Percentage 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, ,001 – 460,000 20,001 – 170, ,001 – 230,000 Countries in Africa with largest number of HIV-infected children Country# of infected children South Africa460,000 Nigeria440,000 Tanzania230,000 Kenya220,000 Mozambique200,000 Zimbabwe200,000 Top Six Countries Source: UNAIDS estimates, 2011 and 2012 Estimated 3 Million HIV Positive Children Globally

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

HIV Prevalence in Key Populations MainlandZanzibar (ZACP, 2007)(ZACP, 2011) FSW 31.4 (NACP, 2010) PWID 42 (MUHAS, 2009) MSM 30* (UDSM, 2012) * 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) HCT27%36% Condoms44%90% Current Coverage Target (2018) Sex workers5%80% MSM40%80% PWID20%50% PMTCT69%100% ART69% of <35095% of <500 GOALS Model

Funding Sources PEPFAR – COP13 = $347M – COP14 = $375M (submitted) Global Fund – $384 M ($191M new) NMSF Grant pool-funded – Canada DFATD : $45M CAD – DANIDA: $39M – 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 Requests ModuleAllocation ($)Allocation %Above Allocation ($)Full Request ($) Prev-Gen Pop$9,214,8044%$8,000,000$17,214,804 Prev-MSM/TG$1,100,0000.5%$840,000$1,940,000 Prev-SW$3,400,0001%$1,800,000$5,200,000 PMTCT$34,091,61115%$34,124,980$68,216,591 HIV C&T$144,407,16263%$204,712,793$248,119,954 TB C&T$15,555,2847%$9,151,800$20,040,931 TB/HIV$2,959,2311%$3,998,152$6,105,376 MDR-TB$4,287,9182%$6,318,381$8,797,952 PSM$2,248,8931%$1,540,000$3,788,893 HMIS/M&E$5,032,0572%$15,252,950$20,285,008 CSS$1,900,0001%$1,554,000$3,454,000 Program Mgmt$5,351,5532%$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 HTC Preliminary Analysis Undergoing Review and Revisions

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

ScenarioInfections Averted ( ) Co NMSF1.2 M PMTCT0.2 M ART0.7 M Strategic0.9M FSW mod0.1 M FSW opt0.2 M Optimal0.9M

ScenarioResources Needed (Billions of US$) ( ) 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 ( )

Summary Resource needs for full scale up would be 150% higher by 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 prevention through prioritisation of the people and places in greatest need: a modelling study

TOGETHER, STRATEGICALLY, WE CAN CONTROL THIS EPIDEMIC Thank you!