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Brazzaville, Congo 5-7 March 2014 5th Inter-Agency Meeting on Coordination and Harmonization of HIV/AIDS, TB and Malaria Strategies

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Treatment 2015 launch

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The agreed target

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.. and focusing on treatment is strategic

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20152003 Treatment continues to expand

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Gaps in global antiretroviral coverage under the 2010 and 2013 WHO HIV treatment guidelines Eligible but not receiving treatment Eligible and receiving treatment Total eligible: *Numbers of people receiving treatment in December 2012 versus (a) the numbers eligible in December 2012 under the 2010 WHO guidelines; (b) the numbers eligible in December 2013, under the 2013 WHO guidelines. 18,563,000 28,600,000 2010 guidelines*2013 guidelines* 14,000,000 66% 39%

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Source: UNAIDS estimates 2013 Gap in antiretroviral coverage varies within Africa

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The agreed target is still ambitious and is a stepping stone towards treatment for all in need

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UNAIDS PCB calls for new targets Encompass new science Drive progress Guide action beyond 2015 Ultimately aspire to end the AIDS epidemic

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Challenges ahead: 1- Societal Lack of knowledge of HIV status Punitive policies and laws Stigma and discrimination

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Cost of treatment per ART patient year by country US Dollars Challenges ahead: 2- diverse facility level costs *Republic of South Africa: costs include updated antiretroviral prices, which were renegotiated by the RSA government in early 2010 and are 53% lower than those observed during the costing period. US$ Average Maximum Minimum US$136 US$186 US$232 US$278 US$682 South Africa*

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Challenges ahead: 3- treatment cascade Sources: 1. UNAIDS 2012 estimates; 2. Demographic and Health Surveys, 20072011 (www.measuredhs.com); 3. Kranzer, K., van Schaik, N., et al. (2011), PLoS ONE; 4. GARPR 2012;www.measuredhs.com 5. Barth R E, van der Loeff MR, et al. (2010), Lancet Infect Disease. Notes: No systematic data are available for the proportion of people living with HIV who are linked to care, although this is a vital step to ensuring viral suppression in the community.

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Challenges ahead: 4- delivery systems Relative likelihood of HIV-positive adults (15-49 years) accessing antiretroviral therapy due to the distance from their nearest primary healthcare facility. Source: Location, Location: Connecting people faster to HIV services, UNAIDS; Geneva, 2013

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Challenges ahead: 5- Key populations and partners a substantial share of new infections Nigeria 51% Kenya about 33% Mozambique more than 25% Morocco 80% Dominican Rep. 47% Peru 65%

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Expected impact of HIV treatment in survival of a 20 years old person living with HIV in a high income setting (different periods) HIV treatment can normalize survival

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What we can achieve Projected annual AIDS-related deaths, assuming scale up to 95% coverage by 2020

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Expanding access to ART is a smart investment: Case of South Africa Source: Expanding ART for Treatment and Prevention of HIV in South Africa: Estimated Cost and Cost-Effectiveness 2011-2050. PLoS ONE 7(2):e30216

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With international support, universal access to ART is at reach in low- and middle income countries Malawi Lesotho Zimbabwe Mozambique Burundi Uganda Central African Rep. Tanzania Zambia Swaziland Kenya Liberia Togo Rwanda Sierra Leone Cameroon Chad Guinea-Bissau Cte dIvoire Botswana Haiti Guinea Namibia Djibouti Nigeria South Africa Burkina Faso Niger Benin Eritrea Ghana Mali Cambodia Belize Myanmar Senegal ART costs as a percentage of GDP 012345678% 2% 5% 5% 8% 0.1% 1% 1% 2% Source: Williams arXiv 2012: http://arxiv.org/abs/1206.6774

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The tasks ahead Source: Terhorst, D & Schmid, G., WHO 2006 Country consultations Regional consultations Dialogue with key strategic partners Global consensus meeting Consultations (Countries, regions, ad hoc) Develop instruments (to support partners) Modelling Costing Supply forecast Testing campaign Demand Resources Progress Monitoring and evaluation

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Making it work: The African Union Roadmap Sustainable financing models Access to medicines Local production and regulatory harmonization Leadership, governance and oversight