Arv programme summary

ARV programme overview SOURCE: South Africa HIV/AIDS response stakeholder interviews; Project team analysis ,[object Object],[object Object],[object Object],[object Object],Overview ,[object Object],[object Object],[object Object],Structure ,[object Object],[object Object],Implemen-tation model ,[object Object],[object Object],Financing

South Africa faces the world’s worst HIV epidemic –HIV prevalence seems to have stabilized, but at a very high level 0 ,[object Object],[object Object],[object Object],[object Object],[object Object],SOURCE: KYE/KYR reports, 2011; Spectrum estimations and mid-year population estimates from www.statssa.gov.za 92 1990 2008 06 04 02 2000 98 Number (infected, newly infected, died) 96 94 Population Millions AIDS-related deaths Annual new HIV infections People living with HIV Total population 1 People Living with HIV/AIDS

ARV roll-out is driving HIV prevalence up even further SOURCE: HSRC survey reports; ART-adjusted data: Rehle et al., 2010; K Y E/K Y R reports, 2011 ,[object Object],[object Object],HIV prevalence Percent 2002 2006 2008 2008, ART adjusted Pre-2002 level

South Africa’s treatment program is the largest in the world, but there is need to further slow infections and further expand coverage 9 SOURCE: Nathea Nicolay, Summary of provincial HIV and AIDS statistics for South Africa, Metropolitan, 2008; NDOH programme data 2008,2009, ,[object Object],[object Object],[object Object],Provincial distribution of those in need of ARV and those receiving treatment 2008 figures, ‘000 2008 2009 % of those in need of treatment enrolled in the ART programme Children Adults 297 43% 73 71 87 Mpuma-langa 44% Free State 49% North West 44% 92 293 47% Eastern Cape 60% 111 44% Kwazulu-Natal Gauteng Western Cape 55 75% Limpopo Northern Cape 11 55% Total people accessing ART (mid year) Total people in need of ART (mid year)

New South Africa guidelines have expanded coverage, but there is still a way to go to align with international standards Old South African guidelines Eligibility ,[object Object],[object Object],Regimens ,[object Object],[object Object],New South African guidelines Eligibility ,[object Object],[object Object],Regimens ,[object Object],[object Object],Full WHO guidelines Eligibility ,[object Object],[object Object],Regimens ,[object Object],SOURCE: Total cost and potential cost savings of the national antiretroviral treatment (ART) programme in South Africa 2010 to 2017; Author: Gesine Meyer-Rath et. al; Date: April 12, 2011

Aggressive task shifting and strengthened, centralized procurement capabilities are required to keep costs under control 5 SOURCE: Total cost and potential cost savings of the national antiretroviral treatment (ART) programme in South Africa 2010 to 2017; Author: Gesine Meyer-Rath et. al; Date: April 12, 2011 2,245 New guidelines 1,161 2,994 Old guidelines 1,055 2010/11 2016/17 1,969 1,504 8,180 9,946 -33 -35 Change on old GL (full cost) Percent 10 33 -29 -12 -18 – Full WHO guidelines 1,415 3,494 2,345 12,077 -33 Change on old GL (full cost) Percent 34 56 12,200 15,251 25 18,125 49 -0.1 – ,[object Object],[object Object],$ Millions, 2009 Reduced cost (with task-shifting and cheaper fixed-dose combinations) Total Full cost (staffing and drug cost as current) Total Scenario Change on full cost Percent -11 4

If new drug purchasing mechanisms and task-shifting are implemented, costs can be kept under control even with expanded guidelines s Full WHO guidelines New guidelines Old guidelines SOURCE: Total cost and potential cost savings of the national antiretroviral treatment (ART) programme in South Africa 2010 to 2017; Author: Gesine Meyer-Rath et. al; Date: April 12, 2011 [BUDGET REVIEW 2010, NATIONAL TREASURY 2012/13 2011/12 2010/11 Full WHO guidelines New guidelines Old guidelines % Percentage of budget at full cost Percentage of budget at reduced cost (TS and RL/FDC)

Summary of patients initiated on ARVs vs. cost under each set of guidelines 7 SOURCE: Total cost and potential cost savings of the national antiretroviral treatment (ART) programme in South Africa 2010 to 2017; Author: Gesine Meyer-Rath et. Al; Date: April 12, 2011 Total cost USD millions Total patients 12,077 Full WHO guidelines New guidelines 15,251 Old guidelines Total cost (full cost) Total cost (reduced cost) Total patients initiated on ART

There are significant capacity challenges in the programme expansion n ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SOURCE: Global Fund; UNAIDS; Press search, NDOH programme data 2008/09 Key challenges scaling up the ARV programme

Recently, the government has taken steps to address these capacity gaps n SOURCE: Global Fund; UNAIDS; Press search, NDOH programme data 2008/09 Key actions taken by the government ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1 See next slide for cost breakdown

Coordination complexity archetypes – South Africa (province) 1 Includes provider-initiated VCT SOURCE: South Africa HIV/ AIDS stakeholder interviews Medium High Low Extreme Intervention type (primary) ,[object Object],[object Object],[object Object],[object Object],Number of funders ,[object Object],[object Object],[object Object],[object Object],Number of implementers ,[object Object],[object Object],[object Object],[object Object],Examples of programs in archetype ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complexity of the programme Low Medium High Extreme Funders ,[object Object],[object Object],[object Object],Implementers ,[object Object],Size ,[object Object],[object Object],[object Object],[object Object],[object Object],Capabilities required SOURCE: South Africa HIV/AIDS stakeholder interviews

Structure of the HIV response is complex: ARV example SOURCE: Interviews 1 HIV/ AIDS, TB and STD director ILLUSTRATIVE ART lead Provincial National District SANAC Treatment Task Team ART lead Implementers District AIDS council DG=>MoH=> HIV Director Directorate for Treatment Premier=>MEC=> Head of department District HAST Director Provincial HAST 1 director ART lead Provincial AIDS council NGOs NGOs NGOs Gvt clinics/ hospitals NGOs NGOs NGOs NGOs (provide TA/ mobile CT) NGOs NGOs NGOs National NGOs NGOs NGOs NGOs Treatment leads National & provincial ART leads meet quarterly to exchange ideas & information NGOs NGOs NGOs Treatment leads NGOs NGOs NGOs Treatment leads NGOs NGOs NGOs National NGOs NGOs NGOs NGOs International donors

Key ART programme players and roles SOURCE: South Africa HIV/AIDS stakeholders interviews PRELIMINARY Donors and providers of technical assistance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Civil society organisations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Private sector ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Strategy/ Policy Resource allocation (budgeting) Planning Implement-ation Monitoring & reporting Evaluation ,[object Object],[object Object],Government

Landscape of programme execution SOURCE: South Africa HIV/AIDS stakeholder interviews PRELIMINARY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Strategy/ Policy Resource allocation (budgeting) Planning Implementation Monitoring & reporting Evaluation

Funding flows, technical support, and accountability lines flow through multiple stakeholders in the ARV programme Funding flows Reporting/account-ability mechanisms Technical support SOURCE: The Second Botswana National Strategic Framework for HIV and AIDS, 2010-2016; PEPFAR; UNGASS 2010 Botswana Country Progress Report; PEPFAR Partnership Framework; UNAIDS Country Harmonization and Alignment Tool (CHAT); interviews; team analysis District Health Facilities NGOs/CSOs International Partners Government of South Africa National DOH Mobile Clinics Provincial DoH SANAC NGOs/CSOs EU+ donors PEPFAR Global Fund PRELIMINARY

Arv programme summary

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