Global Fund investments in HIV

Transcription

1 Global Fund investments in HIV Dr Ade Fakoya, Senior Specialist, HIV Technical Partnerships and Advisory Team Strategic Investment and Partnerships Department

2 Summary Present a financial overview of current Global Fund investments in the HIV Portfolio Discuss the methodology of the work to improve the procurement forecasting of Health products, Provide an overview of results expected Provide headline figures in graphic form Additional slides on transitioning from Stavudine based ART in key countries

3 Overall investment in HIV portfolio (active grants) 13,085,377, ,099,890, ,562,283, ,695,763, Total Lifetime Budget Total Board Approved Total Committed Total Disbursed

4 Results From Global Fund Supported Programs Addis Ababa 04 December 2011

5 HIV/AIDS portfolio: Expenditure per SDA for active grants Program Management and Administration,Monit oring & Evaluation 11% Prevention: PMTCT 6% Community Systems Strengthening 6% Care and Support 9% TB/HIV 0% Antiretroviral treatment (ARV) and monitoring 28% Health Systems Strengthening 13% Prevention 27%

6 Allocation of Global Fund commitments under active HIV grants in the 14 MC priority countries Advocacy 10% PMTCT ( not including ART) 4% HSS 18% ART 39% CSS 4% Care & Support 8% Condoms 3% Counseling and Testing 7% MC 1% General Prevention 7%

7 Improving the management and use of health product information Short term: consolidate and analyze information from procurement plans for Target: to capture 60-70% planned procurement by end Q Pharmaceuticals: ARVs; ACTs; 1st & 2nd line TB Health Products: Rapid tests for HIV & malaria; other key diagnostics (HIV & TB); LLINs; condoms

8 Results Over 300 grants in 70 countries analyzed Outputs: available funding and product categories; inventory of grants planning to procure specific products/groups of products Anti- retroviral medicines by class and drug Projected spend by country approved grants with PSM plans

9 2015 Forecasted Anti-Retroviral Procurement

10 Improving the management and use of health product information II Mid-longer term: IT solution to better manage information on the procurement and supply of health products through the grant cycle Improve management and oversight of health product procurement at the grant level Providing data to forecast demand to engage with industry and other stakeholders Market intelligence

11 transition from D4T- adults* By end 2012 number % By end 2013 number % Bhutan Ethiopia TBC Guinea Malawi 295, Niger Kenya 35, Bolivia Indonesia Haiti Vietnam Dom. Republic Laos ~ Zimbabwe ~161, *Number and percentage of individuals on stavudine based first line regimens

12 Transition beyond 2013, or no current transition end date Country Number of people % Benin Cambodia 20, India ~190, Mali Myanmar Nepal South Africa ~550, Sudan North 173 6

13 Completed by 2014 or later By 2013 By 2012 Theoretical additional costs & bottlenecks Number of [Minimum] [Maximum] Country adults on D4T d4t+3tc ($36) -> TDF+3TC ($65) d4t+3tc+nvp ($56) -> TDF+3TC+EFV ($165) d4t+3tc ($36) -> TDF+FTC+EFV ($203) Action taken Buthan, Bolivia, Dom. Republic, Laos, Niger, Haiti 5,860 $ 169,940 $ 638,740 $ 978,620 Guinea 1,702 No disbursement for Stavudine yet, but soon. Still some stock! Will look into possibilities to $ 49,358 $ 185,518 $ 284,234 procure alternatives to Stavudine. Zimbabwe 161,370 $ 4,679,730 $ 17,589,330 $ 26,948,790 Subtotal, end 2012 needs $ 4,899,028 $ 18,413,588 $ 28,211,644 Nepal, Indonesia, Vietnam, Kenya, Ethiopia 135,540 $ 3,930,660 $ 14,773,860 $ 22,635,180 Tanzania 100,000 $ 2,900,000 $ 10,900,000 $ 16,700,000 Malawi 295,304 $ 8,563,816 $ 32,188,136 $ 49,315,768 Subtotal, end 2013 needs $ 15,394,476 $ 57,861,996 $ 88,650,948 Sudan North 173 India 190,000 Benin 9,179 Mali 9,432 Myanmar 9,709 Cambodia 20,820 South Africa* 371,000 Subtotal, beyond 2013 needs additional drug costs, per patient for the first year Phasing out already started but slow because 1/ frequent imminent stock out of Zidovudine and Tenofovir, 2/ inadequate financial resources, 2/clinicians and patients resist to change to newer recommended regimens. PFM is in country and will confirm info. $ 5,017 $ 18,857 $ 28,891 No bottlenecks identified to date. GF believes these are residual patients (6%) that cannot be transitionned. To Be Confirmed. Since July 2012, no more new patients under Stavudine. Patients under d4t based regimen for 6-24 months will be shifted in phase 1 starting Jan 2013/ after supplies from current procurement cycle are in place. Patients on d4t for more than 24 months shifted in phase 2 (from Dec 2013 $ 5,510,000 $ 20,710,000 $ 31,730,000 after completion of phase 1). Currently preparing/reviewing PSM plan for Phase 2. Will elaborate transition plan. Has still $ 266,191 $ 1,000,511 $ 1,532,893 Stavudine stock but was removed from 2013 PSM plan. Currently preparing/reviewing PSM plan for Phase 2. TA scheduled to streamline the treatment $ 273,528 $ 1,028,088 $ 1,575,144 regimens. Will include phase out of Stavudine. Lack of funding. Current budget covers only 1/3 of people in need of ART (with stavudine). If $ 281,561 $ 1,058,281 $ 1,621,403 switched to Tenofovir, would be lower. $ 603,780 $ 2,269,380 $ 3,476,940 $ 10,759,000 $ 40,439,000 $ 61,957,000 $ 17,699,077 $ 66,524,117 $ 101,922,271 Not planned as part of the Phase 1 budget (ending at end 2013). Will be planned for Phase 2. Could also be done in 2013 with Phase 1 savings. TBD 10% of ARVs are financed via the Global Fund, 90% from national budget. Treatment guidelines revised in 2010/2011. Since 2011, all new patients were initiated on AZT and Tinofivir. Old patients are not transitioned if they are stable on D4T. Estimation of 20% transitionning per year. Additional drug expenses $ 37,992,581 $ 142,799,701 $ 218,784,863 NB: The cost of regimen is culcurated based on the median price from WHO's Global Price Reporting Mechanism a* Participation of the GF in South Africa's ARV budget is 10%

14 Conclusions Global Fund has large investments in antiretroviral therapy Committed to continued support but need to increase domestic government contributions (counterpart financing ) to ensure sustainability Aim to improve forecasting for ART and other health products Need to better understand regional variations in targets and coverage and built in the flexibility to respond to changes in normative guidelines