PEPFAR Scenario –based Cost Projections for PEPFAR Resource Requirements for the ART Program in Ethiopia from FY2011 – FY2015 Solomon Ahmed, M.D. Technical Officer-Treatment Centers for Disease Control and Prevention-Ethiopia AIDS Turning the Tide Together

Background-Ethiopia Total Population – 80 million+ HIV prevalence* – 2.4% ART eligible – 397,818 (26,053 < 15 years) Currently on ART March 2012** – 257,000+ * 1.5% from the 2011 DHS results. ** PEPFAR Ethiopia SAPR

700, , , , , , ,000 Background - Ethiopia Number of PLHIV Trends in no. of PLHIV enrolled to care and ART in Ethiopia from Year HSDP IV Annual Performance Report EFY 2003 (2010/11)

Activities supported for site level services PEPFARGlobal FundGovernment of Ethiopia Site support (mentoring, supervision, supplies, equipment, renovation) In-service training Lab monitoring M & E Support staff Procurement of ARV drugs and OI drugs Infrastructure Clinical staff

Objective of study Provide PEPFAR-Ethiopia with funding projections for different scenarios of scale-up

Methods Utilized results from FY 2010 expenditure analysis to calculate unit costs Used the PEPFAR ART Costing model 2010 Developed different scenarios based on rates of enrollment of new patients

Service delivery support Procurement cost of ARVs (contingency), lab reagents, and other commodities Technical support and managerial overheads provided by PEPFAR-funded implementing partners PEPFAR expenditures included

PEPFAR expenditures excluded Managerial overheads incurred within USG government agencies Costs of related services from other program areas (HIV testing, PMTCT, community-based care)

Scale-up Scenarios used for cost projections Scenario Description 1Current pace of new patient enrollment – 4000/month 250 % reduction in ART enrollment to 2000/month 3Slow linear scale-up to universal access targets (achieving universal access targets by the end of the fourth year) 4Rapid scale-up to universal access targets (achieving universal access targets by the end of the first year)

Assumptions Number of pre-ART patients grows proportional to the number of ART patients Pediatric ART proportion increases from 5.9% to 9.0% of total on ART by the end of FY2015 Patients on 2 nd line regimens increase from 0.6% to 4.8% of total on ART by the end of FY2015

Estimated unit cost for ART and pre-ART patients Average annual per patient costs of $202 for ART patients and $94 for pre-ART patients Per patient costs expected to be relatively flat over the period of projection

ART program scale-up trends in alternate scenarios No. of ART patients 600, , , , , ,000

Comparisons of trends in projected costs under different scenarios FY

Conclusions Cost projections facilitate informed planning Projections offer options of ART scale-up Current trend in patient uptake in Ethiopia fall short of attaining Universal Access by 2015

Acknowledgments Nick Menzies – ICF MACRO Thomas Kenyon – CDC Ethiopia Zenebe Melaku – CU ICAP Tsigereda Gadisa – CU ICAP Bill Graham – UW ITECH Getachew Feleke – UW ITECH Solomon Zewdu – JHU Misrak Makonnen – CRS/AIDSRelief Diana Mattanovich – UCSD Yoseph Mamo –UCSD Thomas Heller – CDC Ethiopia Cate McKinney – CDC Ethiopia Abubaker Bedri – CDC Ethiopia All CDC Ethiopia technical staff