1. Financing HIV, Hepatitis and STI Strategies:
Costing and financing ending the epidemics
Daniel Low-Beer
Durban, 2016

2. Financing strategies in the context of universal health coverage
Financing as well as costing
Market dynamics and efficiencies
Innovations and synergies
Co-financing and savings
Financing Impact and Universal Coverage
Goal of ending the epidemics: SDGs for HIV and Hepatitis
Common framework: HIV, Hepatitis, STIs
Global and country investment cases: negotiating costing
How to make it possible – financing is strategic component

3. HIV strategy – Methodology and Results
Health sector component aligned with UNAIDS strategy
Costs are calculated for 120 low and middle income countries across the six WHO regions (Avenir, Imperial, UNAIDS, WHO)
Unit costs are based on reviews of costing studies reviewed by an expert panel – assume some decline in ARV, in lab costs (as testing regimes are simplified) and service deliver costs (differentiated care). VMMC, PMTCT, Testing and newly enrolled also start to decline by 2020.
Costs increase from US$ 20 billion in 2016 to 22 billion in 2020 and decline to 21 billion in 2021
ARVS 47% of total, program enablers 13%, Testing 9%, condoms 8%
South Africa, Nigeria, Brazil, China are 1/3rd of costs
55% in African Region

4. Health Sector HIV Strategy – fast tracking for sustainability

5. Implementing the Hepatitis Strategy – initial stage of market dynamics
Peaks at 5.2 billion US$ p.a. in 2026

6. Strategic costing: how can elimination be made affordable ?
Radical reductions in treatment costs
By 2020 with increased efficiencies by 2030
By income: low, middle, high income countries
Towards more effective public health spending i.e. reducing ineffective treatment and care costs, estimated as high in middle and higher income countries
Shared costs with other strategies
Harm reduction costs, contribution of hepatitis programs
Immunization and blood safety
Co-infection with HIV and service delivery
Innovations and efficiencies over time
Simplified treatment package, non specialist care, hepatitis B cure (not included)

7. Conclusion: financing in the context of universal health coverage
Financing strategies not just costing
Allocative and Efficiency studies
Innovation and market dynamics
Innovative financing, social insurance, health financing
Negotiation of country investment cases
Common costing frameworks
HIV, Hepatitis, STIs, Health Accounts
STI costs increase from US$2.6 to US$4 billion in 2020, driven by scale up of HPV vaccination and treatment.
Shared costs and synergies: harm reduction, testing, health system
Ask is ending HIV and Hepatitis feasible, but how do we make it feasible