International AIDS Society

UNAIDS Group Proposes Integrated Approach to HIV/AIDS Investment

Author: Mark Mascolini

10 June 2011

Working with UNAIDS, a group of international HIV experts proposes a radically new approach to financial support for HIV/AIDS designed to overcome the unintegrated efforts that have prevailed until now. The new strategy aims for universal access to HIV prevention, treatment, care, and support by 2015.

Using modeling projections, these researchers figure that implementing the new framework could avert 12.2 million new HIV infections and 7.4 million deaths from AIDS between 2011 and 2020 compared with existing schemes.

“Until now,” Bernhard Schwartländer and colleagues observe, “advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects.” To overcome the disadvantages of that approach, the researchers propose “a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system.”

Basic program activities addressed in the new framework are (1) prevention of mother-to-child transmission, (2) condom promotion and distribution, (3) a focus on key populations (sex workers, men who have sex with men, injection drug users), (4) treatment, care, and support for people with HIV, including facility-based testing, (5) male circumcision, and (6) behavior-change programs. Integrating diverse programs would aim to (1) reduce risk, (2) reduce the likelihood of transmission, and (3) reduce morbidity and mortality.

The yearly cost for universal access to HIV prevention, treatment, care, and support would rise from the current level of $16 billion to a peak of $22 billion in 2015, when the researchers project universal coverage would be achieved. From that point, expenditures would decline for three reasons:

“First, coverage will have reached target rates for the interventions included in the new framework and will be kept stable at these rates; second, efficiency gains will continue to be achieved, in particular through cost savings in treatment commodities, simplification of laboratory monitoring, and a shift to community-based approaches in treatment and testing; and third, the decrease in new infections will start to result in decreased need for services for people who live with HIV/AIDS.”

The model projects that the integrated framework would avert 12.2 million new HIV infections from 2011 through 2020, while preventing 7.4 million deaths from AIDS and resulting in 29.4 million life-years gained. The new framework would be cost-effective at $1060 per life-year gained, and additional expenditures to support the framework would be “largely offset from savings in treatment costs alone.”

Adopting this approach, the authors maintain, “would be a striking departure from business as usual for governments, financiers, implementers, normative agencies, and providers of technical support. If all partners commit to a radically more effective approach to HIV/AIDS spending than exists at present, then notable gains in infections averted and life years gained will be achieved from a funding increase of a third in the short term and a funding rate of an extra 20% per year in the medium term.”

Source: Bernhard Schwartländer John Stover, Timothy Hallett, Rifat Atun, Carlos Avila, Eleanor Gouws, Michael Bartos, Peter D. Ghys, Marjorie Opuni, David Barr, Ramzi Alsallaq, Lori Bollinger, Marcelo de Freitas, Geoffrey Garnett, Charles Holmes, Ken Legins, Yogan Pillay, Anderson Eduardo Stanciole, Craig McClure, Gottfried Hirnschall, Marie Laga, Nancy Padian, on behalf of the Investment Framework Study Group. Towards an improved investment approach for an effective response to HIV/AIDS. Lancet. Published on 3 June 2011.

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