What is required to end the AIDS epidemic as a public health threat by 2030? the cost and impact of the fast-track approach

Fast Track Modeling Working Group

doi:10.1371/journal.pone.0154893

What is required to end the AIDS epidemic as a public health threat by 2030? the cost and impact of the fast-track approach

Fast Track Modeling Working Group

Management Science

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Abstract

In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually - far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US$7.4Bn in low-income countries, US$8.2Bn in lower middle-income countries and US$10.5Bn in upper-middle-income-countries by 2020 before declining approximately 9% by 2030.

Original language	English
Article number	e0154893
Pages (from-to)	1-14
Number of pages	14
Journal	PLoS ONE
Volume	11
Issue number	5
DOIs	https://doi.org/10.1371/journal.pone.0154893
Publication status	Published - 9 May 2016

Funding

Participation of JS and LB was sponsored by the Bill and Melinda Gates Foundation under Grant OPP1186285. We are grateful to the Expert Group on ART costs for their contributions. The group included Meg Doherty, Gundo Weiler, Nathan Ford and Jos Perriens from WHO, Badara Samb from UNAIDS, Jennifer Cohn from M?decins sans Fronti?res, Elya Tagar and Samantha Diamond from the Clinton Health Access Initiative, Sergio Bautista from the Mexican National Institute of Public Health, Andrew Philipps from University College London, Ruben Granich from the U.S. Government's Office of the Global AIDS Coordinator, Brian Williams from SACEMA and Gesine Meyer-Rath from Boston University. Ricardo Valladares from UNAIDS, provided valuable input on the estimation of program support costs, support, critical review and inputs to the execution of the country validation and the project in general. Karl Dehne provided guidance on modeling prevention services. John Blandford (CDC) provided crucial input on the assumptions and inputs for this modeling. Important contributions (assumptions and inputs) for the development of this work was provided by the participants of the April 7-8th, 2014 meeting of the "Fast Track modeling working group": Luiz Loures and Paul de Lay (co-chairs), Mark Dybul, Nicolas Bidault, Obinna Onyekwena, Matt Blakely (Global Fund), Mai Hijazi (US-AID), Julio Montaner (University of British Columbia, Vancouver), Mead Over (Center for Global Development), Anna Vassall (LSHTM), John Stover, Lori Bollinger (Avenir Health), Timothy Brown (East-West Center), Samantha Diamond, Elya Tagar (Clinton Health Access Initiative), Jeffrey Eaton (Imperial College), Brian Williams (SACEMA, SA), Douglas Webb (UNDP), Priscilla A. Idele (UNICEF), Jeremy Addison Lauer (WHO), Gundo Aurel Weiler (WHO), Clemens Benedikt (WB), Jennifer Cohen (MSF), Jose A. Izazola, Ricardo Valladares, Peter D Ghys, Leopold Zekeng, Iris Semini (UNAIDS), Ruy Burgos-Filho (Brazil), Felix Masiye (Zambia), Gesine Meyer-Rath (South Africa). Finally, we would like to thank national analysts for inputs to their countries' Goals files.

Keywords

HIV
preexposure prophylaxis
acquired immune deficiency syndrome
antiviral therapy
disease surveillance
geographic distribution
health care cost
infection prevention
public health

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Cite this

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title = "What is required to end the AIDS epidemic as a public health threat by 2030? the cost and impact of the fast-track approach",

abstract = "In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually - far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90\% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US\$7.4Bn in low-income countries, US\$8.2Bn in lower middle-income countries and US\$10.5Bn in upper-middle-income-countries by 2020 before declining approximately 9\% by 2030.",

keywords = "HIV, preexposure prophylaxis, acquired immune deficiency syndrome, antiviral therapy, disease surveillance, geographic distribution, health care cost, infection prevention, public health",

author = "John Stover and Lori Bollinger and \{Antonio Izazola\}, Jose and Luiz Loures and Paul DeLay and Ghys, \{Peter D.\} and Mark Dybul and Nicolas Bidault and Obinna Onyekwena and Matt Blakely and Mai Hijazi and Julio Montaner and Mead Over and Anna Vassall and Timothy Brown and Samantha Diamond and Elya Tagar and Jeffrey Eaton and Brian Williams and Douglas Webb and Idele, \{Priscilla A.\} and Lauer, \{Jeremy Addison\} and Weiler, \{Gundo Aurel\} and Clemens Benedikt and Jennifer Cohen and Izazola, \{Jose A.\} and Ricardo Valladares and Leopold Zekeng and Iris Semini and Ruy Burgos-Filho and Felix Masiye and Gesine Meyer-Rath and \{Fast Track Modeling Working Group\}",

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AU - Stover, John

AU - Bollinger, Lori

AU - Antonio Izazola, Jose

AU - Loures, Luiz

AU - DeLay, Paul

AU - Ghys, Peter D.

AU - Dybul, Mark

AU - Bidault, Nicolas

AU - Onyekwena, Obinna

AU - Blakely, Matt

AU - Hijazi, Mai

AU - Montaner, Julio

AU - Over, Mead

AU - Vassall, Anna

AU - Brown, Timothy

AU - Diamond, Samantha

AU - Tagar, Elya

AU - Eaton, Jeffrey

AU - Williams, Brian

AU - Webb, Douglas

AU - Idele, Priscilla A.

AU - Lauer, Jeremy Addison

AU - Weiler, Gundo Aurel

AU - Benedikt, Clemens

AU - Cohen, Jennifer

AU - Izazola, Jose A.

AU - Valladares, Ricardo

AU - Zekeng, Leopold

AU - Semini, Iris

AU - Burgos-Filho, Ruy

AU - Masiye, Felix

AU - Meyer-Rath, Gesine

AU - Fast Track Modeling Working Group

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KW - HIV

KW - preexposure prophylaxis

KW - acquired immune deficiency syndrome

KW - antiviral therapy

KW - disease surveillance

KW - geographic distribution

KW - health care cost

KW - infection prevention

KW - public health

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IS - 5

M1 - e0154893

ER -

What is required to end the AIDS epidemic as a public health threat by 2030? the cost and impact of the fast-track approach

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