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Palladium Research Shows Critical HIV Treatment Funding Needs

$53 Billion USD Needed over Next Five Years to Reach UN’s 2020 Targets

A modelling study by Palladium researchers published last week in the journal PLOS Medicine shows that site-level HIV treatment will cost $53 billion in 97 countries worldwide in order to achieve the “90-90-90” treatment targets set by the Joint United Nations Programme on HIV/AIDS. This three-part target, to be met by 2020, aims for 90% of those living with HIV to know their status, for 90% of those diagnosed to receive sustained antiretroviral therapy (ART), and for 90% of those receiving ART to have viral suppression. Meeting these goals is estimated to require an additional 21 million people to be on ART from 2013 to 2020, and anticipated funding levels will not be able to support this ambitious increase in the availability of and access to ART.

In their research for the Health Policy Project, Arin Dutta and Catherine Barker of Palladium and Ashley Kallarakal (formerly of Palladium) analysed three scenarios: (1) continuation of countries’ current ART eligibility policies, (2) universal adoption of the 2013 World Health Organisation (WHO) guidelines and (3) expanded eligibility per the 2015 WHO guidelines to meet the 90-90-90 targets. According to their model, the financial resources required to scale up ART from 2015 to 2020 range from $46 billion USD under the first scenario to $53 billion USD under the third. Depending upon the scenario and contribution levels of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the researchers estimate the funding shortfall over six years to be between $20 and $25 billion USD.

This is the first study to comprehensively project the financial resources needed and available for HIV treatment. Their model is novel in its consideration of uncertainty in underlying data, use of country- and region-specific information, incorporation of different scenarios, disaggregation of results for adults and children and first- versus second-line treatment, and predictions of how costs of medicines and diagnostic supplies may change in the future.

The researchers conclude that the resource shortfalls to adequately scale up ART pose a significant threat to the sustainability of the global HIV response, although the introduction of lower-cost and highly effective antiretroviral regimens may allow more people to be on ART even at current funding levels. Still, the authors point to a need to mobilise additional resources through innovative financing sources and efficiency gains. Says lead author Arin Dutta, “As we move into these ambitious HIV treatment targets, which will save lives and help to curb growth of the epidemic, we need to recognize that traditional sources of funding for the medicines and services will not be sufficient. Governments, especially in middle-income countries, need to do more, and can do more with the help of new sources of financing. Great promise lies in new and more innovative ways to manage patients and to rethink the dosing and type of drugs. There is opportunity as well as challenge in the future of HIV treatment, and we expect that groups like Palladium will continue to assist in key research to help find the way.”