FINANCIAL RESOURCES REQUIRED TO ACHIEVE UNIVERSAL ACCESS TO HIV PREVENTION, TREATMENT, CARE AND SUPPORT

On September 25, 2007, UNAIDS released a new report estimating the financial resources needed for the AIDS response. The report is based on country estimates of need and ability to scale up. The report offers three different scenarios: 1) what would happen if we continued on the trajectory we're currently on; 2) what resources would be required to reach universal access to prevention, care and treatment by 2010 (as promised by the G8) and 3) what resources would be required to reach this goal in 2015.

What is universal access?
The term ‘universal access' does not imply that a particular intervention is actually delivered to each and every individual who needs it, as such a goal would be unrealistic. For different types of interventions (prevention, care, treatment etc), UNAIDS has identified coverage levels it has determined to be equivalent to universal access.

For treatment, "universal access" roughly means 80% of those in need would receive treatment. UNAIDS has also changed the definition of who is "in need" of ARVs. Previously, a person was considered "in need" if they were within two years of otherwise dying from HIV/AIDS. However, UNAIDS is now advocating that patients start treatment earlier and is therefore considering a patient "in need" if they would otherwise die within three years.

Scenario One-Stay the course

• In 2007, spending estimated at $10b but $18b was needed
• If the scale-up of HIV services continues at the same pace as in the recent past, funding is projected to reach $15.4 billion in 2010 and $22.5 billion in 2015.
• This scale up would NOT get us to universal access by either 2010 or 2015. If current trends continue, only 4.6 million people would receive antiretrovirals in 2010 (31% of those in need) and 8 million people would be on antiretrovirals by 2015 (46% of those in need).

Scale up to Universal Access by 2010
To meet the goal of global universal access by 2010, available financial resources for HIV must more than quadruple by 2010 compared to 2007 - up to $42.2 billion and continue to rise to $54.0 billion by 2015.

Such a scale up would result in an increase in treatment coverage to 80% of those in need, ensuring timely administration of antiretrovirals to 13.7 million people in 2010 and to 21.9 million in 2015.

Of the 2010 total of $42.2b:
$15.1b is for prevention (36%);
$15.4b for treatment and care (36%);
$4.4b is for orphans and vulnerable children (10%)
$6.1b is for programmatic / health systems (14%)
$1.3b is for prevention of violence against women (3%)

For purposes of PEPFAR, the 2013 goal for treatment under this scenario would be to treat 19.2 million which would be 82% of those who would otherwise die within three years. An estimated 2013 funding goal (this is not a UNAIDS figure but a DATA derivation) would be approximately $49b annually by 2013.

Scale up to Universal Access in 2015
In the process of setting their national targets, many countries have come to recognize specific obstacles to rapidly scaling up services. The phased scale-up scenario assumes different rates of scale-up for each country based on current service coverage and capacity. This scenario envisions that each country will reach universal access for specific programmatic interventions at different times, with essentially all countries reaching universal access by 2015 at the latest.

This scenario would require a total of $28.4 billion in 2010- almost triple the amount currently available for HIV/AIDS - and $49.5 billion in 2015.

Under the phased scale-up, 8.2 million individuals would be treated by 2010 (only 52% of those in need) and 18.6 million by 2015 which would represent 80% of the three-year need for ART.

Of the 2010 total of $28.4b:
$11.9b is for prevention (42%);
$9.2b is for treatment and care (32%);
$2.5b is for orphans and vulnerable children (9%)
$4.4b is for programmatic / health systems (15%)
$0.4b is for prevention of violence against women (1%)

For purposes of PEPFAR, the 2013 goal for treatment under this scenario would be to treat 14 million which would be 70% of those who would otherwise die within three years. An estimated 2013 funding goal (this is not a UNAIDS figure but a DATA derivation) would be approximately $37b annually by 2013.

General comments about the costings:

• All of the above costings are totals meaning that they are the resources required from domestic resources as well as donor financing. Donors would not be expected to cover all financing requirements.
• Under both scenarios, the resources required for prevention are equal to if not more than the resources required for treatment and care.
• Nearly one quarter of total resources required for HIV will support health systems strengthening.
• These estimates do not include the costs of research and development into new technologies such as vaccines and microbicides.

 

 

Download the UNAIDS Report