Global Fund investments in

HIV

Dr Ade Fakoya,

Senior Specialist, HIV

Technical Partnerships and Advisory Team

Strategic Investment and Partnerships Department

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,

2012-14

• Provide an overview of results expected

• Provide headline figures in ‘graphic form’

• Additional slides on transitioning from Stavudine

based ART in key countries

Overall investment in HIV portfolio

(active grants) 13,085,377,371.10

8,099,890,580.04

6,562,283,086.19

4,695,763,636.74

Total Lifetime Budget Total Board Approved Total Committed Total Disbursed

Results From Global Fund

Supported Programs

04 December 2011 Addis Ababa

HIV/AIDS portfolio: Expenditure per SDA

for active grants

Antiretroviral treatment (ARV) and

monitoring 28%

Prevention 27%

Health Systems Strengthening

13%

Program Management and

Administration,Monitoring & Evaluation

11%

Care and Support

9%

Community Systems Strengthening

6%

Prevention: PMTCT 6%

TB/HIV 0%

PMTCT ( not including ART) 4%

ART 39%

General Prevention

7%

MC 1%

Counseling and Testing

7% Condoms 3%

Care & Support 8%

CSS 4%

HSS 18%

Advocacy 10%

Allocation of Global Fund commitments under active HIV grants in the 14 MC priority countries

Improving the management and use of

health product information

• Short term: consolidate and analyze information

from procurement plans for 2012-2014.

• Target: to capture 60-70% planned procurement

by end Q4 2012

• Pharmaceuticals: ARVs; ACTs; 1st & 2nd line TB

• Health Products: Rapid tests for HIV & malaria;

other key diagnostics (HIV & TB); LLINs; condoms

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

2011

2012

2013

2014

2015

Forecasted Anti-Retroviral Procurement 2012-2015

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

transition from D4T- adults*

By end 2012 number % By end 2013 number %

Bhutan 4 4.0 Ethiopia TBC

Guinea 1702 12.7 Malawi 295,304 75

Niger 1467 16.0 Kenya 35,121 16

Bolivia 29 2.0 Indonesia 6001 25

Haiti 2176 14.0 Vietnam 8420 17

Dom. Republic 1064 6.6

Laos ~1120 24.8

Zimbabwe ~161,370 35.0

*Number and percentage of individuals on stavudine based first line regimens

Transition beyond 2013, or no current transition end date

Country Number of people %

Benin 8589 41

Cambodia 20,820 44

India ~190,000 45

Mali 1467 31.5

Myanmar 9709 48

Nepal 1926 27

South Africa ~550,000 40

Sudan North 173 6

Theoretical additional costs & bottlenecks

[Minimum]

d4T+3TC ($36) ->

TDF+3TC ($65)

d4T+3TC+NVP ($56) ->

TDF+3TC+EFV ($165)

[Maximum]

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

49,358$ 185,518$ 284,234$

No disbursement for Stavudine yet, but soon. Still some stock ! Will look into possibilities to

procure alternatives to Stavudine.

Zimbabwe 161,370 4,679,730$ 17,589,330$ 26,948,790$

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$

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.

Malawi 295,304 8,563,816$ 32,188,136$ 49,315,768$

15,394,476$ 57,861,996$ 88,650,948$

Sudan North 173

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.

India 190,000

5,510,000$ 20,710,000$ 31,730,000$

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

after completion of phase 1).

Benin 9,179

266,191$ 1,000,511$ 1,532,893$

Currently preparing/reviewing PSM plan for Phase 2. Will elaborate transition plan. Has still

Stavudine stock but was removed from 2013 PSM plan.

Mali 9,432

273,528$ 1,028,088$ 1,575,144$

Currently preparing/reviewing PSM plan for Phase 2. TA scheduled to streamline the treatment

regimens. Will include phase out of Stavudine.

Myanmar 9,709

281,561$ 1,058,281$ 1,621,403$

Lack of funding. Current budget covers only 1/3 of people in need of ART (with stavudine). If

switched to Tenofovir, would be lower.

Cambodia 20,820

603,780$ 2,269,380$ 3,476,940$

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

South Africa* 371,000

10,759,000$ 40,439,000$ 61,957,000$

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.

17,699,077$ 66,524,117$ 101,922,271$

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 as of 2012/10/11* Participation of the GF in South Africa's ARV budget is 10%

http://apps.who.int/hiv/amds/price/hdd/

Country

Number of

adults on

D4T

additional drug costs, per patient for the first year

By 2

012

Subtotal, end 2012 needs

By 2

013

Subtotal, end 2013 needs

Subtotal, beyond 2013 needs

Co

mp

lete

d b

y 2

014 o

r la

ter

Conclusions

• Global Fund has large investments in anti-

retroviral 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