Investment model outlines the way forward on global AIDS

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Key changes to the way global HIV/AIDS investments are made, with an accompanied boost to investment by 2015, could dramatically change the future trajectory of the AIDS pandemic. That’s according to Dr. Bernhard Schwartländer and other members of the Investment Framework Study Group convened by the Joint United Nations Program on HIV/AIDS (UNAIDS), who developed a new model to overhaul global AIDS spending that appeared in an article in Health Policy, published early by The Lancet.

“The new model proposes a paradigm shift in the way AIDS funding is approached, with a greater emphasis on priority setting and optimization of AIDS responses, a shift to community mobilization to deliver programs and greater synergies between program elements,” according to a press release from the Joint United Nations Program on HIV/AIDS (UNAIDS).

The article, entitled “Towards an improved investment approach for an effective response to HIV/AIDS,” argues that advocacy for resources has failed to take into account the relative effects of pushing for scale up of various strategies. Authors 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,” according to the article abstract.  Dramatic scale-up of antiretroviral treatment is a centerpiece of the model—an intervention valued for its impact on HIV mortality, TB morbidity and mortality, and its impact on prevention of new infections.  The recent groundbreaking results of HPTN 052 are referenced.

Implementing the model, however, would require a bump in funding of 30 percent over currently available levels by 2015, when universal access treatment targets would be achieved and expenditures are expected to peak.

“Increasing the funding available globally by $5 billion per year by 2015 would prevent over 12 million new infections and save over 7 million lives,” according to a press release from the Treatment Action Group (TAG). “In turn, this modest increase would also reduce the cost of the AIDS response in the long term.”

The article states that the estimated yearly cost to achieve universal access to HIV prevention, treatment, care and support by 2015 is least $22 billion. “The additional investment proposed would be largely offset from savings in treatment costs alone,” according to the article.

“Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends,” Schwartländer said in the UNAIDS press release. “We propose an investment framework to support management of national and international HIV/AIDS responses, encourage transparency in program objectives and results, and enable decision makers and financiers to galvanize support for effective action.”

Some of the key interventions included in the model, in addition to antiretroviral therapy for persons who are HIV infected, are activities to reduce vertical transmission, expand access to medical male circumcision services, targeted interventions for key populations such as scale up of syringe exchange programs and opioid substitution therapy for injection drug users, and condom promotion and distribution.

Despite the additional costs required to implement the investment model, the framework is cost-effective at $1060 per life year gained.

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