2. World Vision Experiences in Making ART Treatment Affordable and Available Dr. Daniel J Malleboyina M.B.B.S, MBA, MPH Regional Advisor HIV & AIDS- Asia Pacific Region WORLD VISION

3. ACCESS to TREATMENT o Understanding the dynamics of treatment is critical to facilitate access. (Technical, Availability of drugs & Compliance) o Free ARV's does not mean that there will be a free ride. It still costs to get ARV's o Expanded response of Access to treatment of ART decreases the incidence of HIV o Children need special budgetary allocation for HIV treatment and custom made drugs - WV is advocating for 12% budgetary allocation for children

4. AFFORDABILITY o ART’s are being made Affordable ($132-140US per year in low economic countries and $3-$4 dollar for CD4 test) o Affordability to treatment is directly dependent on Leadership. (Individuals, International bodies (UNGASS), NGO's(Positive Action Foundation in Philippines), Governments and the communities) o Treatment Affordability is becoming possible through true commitment in multi-sectoral partnerships o There is a lot still to be accomplished and more advocacy for ART’s is still needed.

5. Elements of the ART Capsule o Costs - Drugs take 50% - 75% of the budget for HIV – reduce mortality and morbidity, decrease in hospitalizations costs, decreases in new HIV infection o Capacity Building of the health care system – Docs, nurses & lab staff o Lab facilities – equipment, maintenance, continuous supply of electricity o Supply chain management of ARV’s, OI drugs and laboratory material o Financial management is also very critical o Leadership is critical and control of corruption o Adherence + Money for OI and Transportation o Other issues like confidentiality, home based care, counseling, etc

6. ARV financing o 50-80% of the funding is from external sources in low income countries – either from individuals, Global Fund, PEPFAR, Bilateral & Multilateral donors, Faith Based Organizations & Foundations, UN and WHO o PLWHA’s – their personal contribution to treatment of ART and OI is much higher than governments o Clinton Efforts in making ARV’s affordable to the poorest should never be forgotten -

7. Government Financing o Mainstreaming - into Government budget has been effective. ex: Kenya & Tanzania (Tanzania - from $36 million in 03 to 286 million in 06-07); Increases non-health sectoral involvement; need coordination, o Universal Access to therapy in Brazil – Government is making this possible though there are challenges. 17 of the ARV drugs available with 8 being produced in Brazil

8. Community Financing o African Health Project (Kogi State in Nigeria) – worked with 212 public schools (140,000 children) secondary schools and raised funds for the infected. o Capacity building of 5000 General doctors South Africa for ART treatment

9. World Vision Financing - CSO have been financing some elements of ART capsule o Cambodia – build capacity National Pediatric hospital into excellence center for pediatric ART; Home based care and OI for PLWHA’s – WV assisting 3000 to 5000 to get ARV’s in 9 provinces with home based care team; o India – HIV doctor giving ART and OI treatment in Chennai in India; the center provides VCT and Micro-nutrition, linkages to the TB center for 1400+ PLWHA’s o Ghana – WV spends 60% of the National budget on ARV’s o PNG – Assistance provided to 300 PLWHA’s o Financing for transportation, OI’s & nutrition

10. World Vision Financing Somalia – ART treatment commenced by WV and taken over by UN Agencies Armenia – Principal recipient of ARV’s (Global Fund) Zambia – in 19 districts WV does comprehensive programs on ART coverage with nutrition in 2 districts o Referrals to Government and Follow up – Malawi, Vietnam, Thailand and Brazil o Several PMTCT programs – Cambodia & Zambia

11. World Vision Advocacy Focus UNGASS o Advocated for special focus on children’s treatment with 800 other CSO’s o World Leaders agreed to ensure that HIV infected women and infants have access to effective treatment to reduce mother to child transmission. o Commitment to intensify investment in research and treatment and R and D for pediatric ART formulations. World leaders recognized the need to provide $20 billion - $23 billion annually to address the global response to HIV and AIDS by 2010. o World Vision welcomes the decisions to set ambitious targets during 2006. However, with the absence of any other timeliness or targets, WV is concerned that with no other time bound targets this may not be achieved.

12. WV Advocacy Focus Con… 1. Stop the needless deaths of parents - ensure at least 80% of adults in need of treatment have access to appropriate antiretroviral therapy. 2. Stop the needless deaths of children - ensure that at least 80% of all children in need of treatment have access to HIV and AIDS treatment, including antiretroviral therapy, and at least 80% of HIV-positive pregnant women have access to prevention of mother- to-child-transmission (PMTCT) services. 3. Improve the lives of orphans and vulnerable children 4. Preserve an HIV-free generation 5. Reduce the unacceptable vulnerability of girls 6. Faith based Approach