The Impact and Cost of the HIV/AIDS Investment Framework for Adolescents

John Stover1, Jim Rosen1, Susan Kasedde2, Priscilla Idele2, Craig McClure2

1Futures Institute, 2UNICEF

Source: Schwartlander, Stover et al 2011, Towards an improved investment approach for an effective response to HIV/AIDS, Lancet; 377: 2031–41.

4

Impact of Investment Framework

5

Estimated Cost of Investment Framework, 2011-2020

6

Purpose: Focus on Adolescents

Apply the Investment Framework analysis to adolescents to determine: Impact of investing in prevention for

adolescents 10-19 on new infections, number of HIV+ adolescents, and adolescent AIDS deaths

Cost of programs by type Number of adolescents needed to be

reached by type of service

7

Population of Developing Countries by Age (Millions), 2012

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80+

-400

,000

,000

-200

,000

,000 0

200,

000,

000

400,

000,

000

Males Fe-males

Pop 10-19 = 19% of total population, 26% of adult population, 17% of sexually active population

8

Scenarios Base

Constant coverage for prevention and treatment Investment Framework (IF)

Coverage scales up to target levels by 2015 Investment Framework Delayed (IF Delayed)

Coverage targets not achieved until 2020 Pessimistic

Lower coverage targets Targets achieved in 2020 Low values of intervention impact

Goals Model

Pop GroupLow RiskMed RiskHigh Risk

MSMIDU

Behavior

Type of Transmissio

nSex

NeedleBloodMTCT

Probability of

Transmission

New HIV Infections

Behavior Change

• Outreach• Education• Communication

Technology•Condoms

•STI Tx•MC•PrEP

•Microbicdes•Vaccines

CoverageEffectiveness

Treatment

10

Methods: Impact Goals model in

Spectrum applied to 28 countries

Results scaled-up to all 120 low and middle income countries

11

Adolescent Percent of Target Population

PMTC

T

Condo

ms

VMMC

Key Po

psC&T

BCCART

Scho

ol

STI T

X

Fam

ily p

lann

ign

OVCs0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

12

Estimating the Adolescent Markup

Program ElementsService Delivery System Support 

Intervention Drugs / Supplies Labor

Equip-ment IEC Training

Super-vision Logistics Mgmt.

Infra-structur

e M&E

Markup

Score

PMTCT                     1.75

Screening + + 2

Family Planning + + + + + + 6

CD4 Testing               0Prophylaxis for HIV infected pregnant women                    

Option A + + 2

Option B + + 2ART for mothers who need it for their own health + + 2

Early infant diagnosis               0

Cotrimoxazole Prophylaxis                   0

Estimating Adolescent Unit Costs

Category Investment Framework Unit Costs

Adolescent

Markup

% Markup

Basic Programs

-PMTCT $300 - $1000 / HIV+ woman Medium 40%

-Condoms $0.08 - $0.27 / condom distributed Low 25%

-Male circumcision $40 - $100 / circumcision Medium 40%

-Key populations (FSW, MSM, IDU)

$20 - $40 /person reached$1000 - $2000 / drug substitution

L/M/H 25/40/50%

-Behavior change $5 - $18 / person reached None 0

-ART $360-$600 / person treated Medium 40%

Critical Enablers

-HIV C&T $1 - $12 - $20 / person tested Medium 40%

-Community mobilization $1 - $3 / person reached High 50%

-Mass media $300,000 - $3M / campaign None 0

Development Synergies

-School-based programs $40 - $200 / teacher trained None 0

-STI treatment $20 - $50 / case treated Medium 40%

-Family planning $8 - $20 / modern method user

High 50%

14

New HIV Infections Among Adolescents

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

BaseIFIF DelayedPessimistic

15

New HIV Infections by Sex (10-19)

2010

2012

2014

2016

2018

2020

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Female: BaseFemale: IFFemale: IFDFemale: Pess.Male: BaseMale: IFMale: IFDMale: Pess.

16

AIDS Deaths Among Adolescents

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020105,000

110,000

115,000

120,000

125,000

130,000

135,000

IFIF DelayedPessimisticBase

17

HIV+ Population (10-19): Investment Framework

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Male 15-19Male 10-14Female 15-19Female 10-14

18

Estimated Resource Needs for Adolescents

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020$0

$1,000,000,000

$2,000,000,000

$3,000,000,000

$4,000,000,000

$5,000,000,000

$6,000,000,000

$7,000,000,000

Basi

c Pro

gra

ms

Cri

tica

l

En

ab

lers

Develo

pm

ent

Syn

erg

ies

19

Estimated Resource Needs for Adolescents

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020$0

$1,000,000,000

$2,000,000,000

$3,000,000,000

$4,000,000,000

$5,000,000,000

$6,000,000,000

$7,000,000,000 OVC

UP

Safe Injection

PEP

Blood safety

STIs

Prisoners

PVAW

Family Planning

Education

International

Logistics

Communica-tions

M&E

Research

Management

Human Rights

Legal

Advocacy

Mass media

Com. Mob.

VCT

BCC

MC

PITC

ART

IDU

MSM

FSW

Condoms

PMTCT

Basi

c Pro

gra

ms

Cri

tica

l

En

ab

lers

Develo

pm

ent

Syn

erg

ies

Largest amounts needed for OVC (20%); ART (9%); STI management (7%); and community mobilization, prevention of gender-based violence and PWID (6% each)

20

Putting Adolescents in Perspective

Adolescents

26%

Resource Needs for Adolescent Response in 2015

21

Conclusions Impact

The IF could avert 1.5 million new adolescent infections by 2020

31% of the total new infections to adolescents under the Base Scenario

A five year delay would reduce impact by 1/3 Poor implementation would result in little decline in

the annual number of new infections Resources for adolescents

Need to expand by 50% to nearly $6 billion by 2015 to achieve goals of Investment Framework

After 2015 needs will decline somewhat due to reductions in new infections

1/3 of needs are for Basic Programs, ¼ for Critical Enablers, 40% for Development Synergies