1. DPG-AIDS Welcome Michelle Roland, Lead On behalf of DPG-AIDS

2. 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

3. Higher Prevalence in Women: Transition to Adulthood Age Percent HIV positive

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

5. 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

6. 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 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

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

8. HIV Prevalence in Key Populations MainlandZanzibar (ZACP, 2007)(ZACP, 2011) FSW 31.4 (NACP, 2010) 10.820.5 PWID 42 (MUHAS, 2009) 1611.3 MSM 30* (UDSM, 2012) 12.32.6* 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

9. 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

10. 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

11. 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

12. ART/Commodity Funding Gap Above Allocation request for key commodities: $193,117,348 – Includes ARVs, RTKs, HEID, and lab reagents for HIV testing

14. 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

15. 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)

16. 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

17. Measuring Program Efficiency: All HTC Preliminary Analysis Undergoing Review and Revisions

19. 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

20. ScenarioInfections Averted (2014-2030) Co NMSF1.2 M PMTCT0.2 M ART0.7 M Strategic0.9M FSW mod0.1 M FSW opt0.2 M Optimal0.9M

21. ScenarioResources 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

22. Cost-Effectiveness by Scenario (2014-2030)

23. 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

24. Maximising the effect of combination HIV prevention through prioritisation of the people and places in greatest need: a modelling study

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