The Global Fund experience and the social research agenda

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Access
Hope
Michel D. Kazatchkine, M.D. The Global Fund
to Fight AIDS, Tuberculosis and Malaria 22 July,
2007
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ACCESS TO ANTIRETROVIRAL TREATMENT 2001-2007

• A change in paradigm about the relationship
  between health and development
• The mobilization of civil society for global
  health
• The mobilization of the political world and the
  mobilization of large resources for AIDS and
  global health
• The access to cheaper drugs and commodities
• The evidence of the feasibility and effectiveness
  of large scale treatment interventions in
  resource-poor settings
• The effective integration of prevention and
  treatment
• The emergence of operational research

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HEALTH AND DEVELOPMENT

• Health not considered anymore as a consequence of
  development but as a factor for development
• The health sector long considered as a
  non-profitable source of expenditure has
  increasingly become understood as a necessary
  investment for development

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MILLENNIUM DEVELOPMENT GOALS

• MDG 1 Eradicate extreme poverty and hunger
• MDG 2 Achieve universal primary education
• MDG 3 Promote gender equality and empower women
• MDG 4 Reduce child mortality
• MDG 5 Improve maternal health
• MDG 6 Combat HIV/AIDS, malaria and other
  diseases
• MDG 7 Ensure environmental sustainability
• MDG 8 Build a partnership for development

Buenos Aires
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AIDS ON THE POLITICAL AGENDA
2000 Okinawa G8 Millennium Development Goals
2001 United Nations General Assembly Special
Session on HIV/AIDS 2002 Global Fund to Fight
AIDS, TB and Malaria 2003 PEPFAR 2005
Universal access Gleneagles G8 and MDG
Summit, New York UNITAID 2007 Heiligendamm G8
Buenos Aires
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THE ROLE OF THE CIVIL SOCIETY IN MOBILIZING FOR
GLOBAL HEALTH

• The power of advocacy by affected people
• The mobilization of civil society in the
  developing world
• The role of civil society in implementation of
  treatment and prevention programs

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AIDS Estimated total annual resources available
19962005
UA goal
3by5
PEPFAR
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GLOBAL FUND 3,000 LIVES SAVED EVERYDAY
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NUMBER OF PEOPLE RECEIVING ART IN LOW AND MIDDLE
INCOME COUNTRIES, 2002-2006
Source WHO/UNAIDS
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COMPARATIVE TREATMENT OUTCOME
Source M. Egger et al, ARTLINC
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PREVENTION AND TREATMENT

• Prevention and treatment mutually reinforce
  each other and are now considered as part of an
  integrated approach to care

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OPERATIONAL RESEARCH EVIDENCE FROM DEVELOPING
COUNTRIES

• Availability of ART positively impacts on the
  motivation for testing and disclosure
• Adherence to ART can be as high, or higher in
  developing countries than in OECD countries
• Lower likelihood of risky behaviors in treated
  individuals

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CLAIMS THAT OPPOSE TREATMENT (2001)

• Prevention should be a priority over treatment
• Antiretroviral treatment is not affordable
• Antiretroviral treatment is not cost-effective
• Effectiveness, tolerance and adherence unknown
• Risk of dissemination of resistant viral strains

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ACCESS TO ANTIRETROVIRAL TREATMENT 2008-2010

• Resources and sustainability
• Drug costs
• Health systems
• Integrating prevention with care
• HIV/TB co-infection
• Monitoring impact
• Policy and advocacy

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GLOBAL RESOURCE NEEDS
Source UNAIDS
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VERTICAL EQUITY IN HEALTH CARE-RELATED OUT OF
POCKET PAYMENTS (Bamako )
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DRUG PRICES FIRST LINE
Source MSF July 2007
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EVOLUTION OF DRUG COSTS
100m
700m
200m
130m
270m
1.9m patients at 140/yr
2.0m patients at end-2008
Effect of 0.1m on 2nd-line
Effect of d4T to AZT
Effect of more EFV for TB
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COUNTRIES WITH CRITICAL SHORTAGES OF HEALTH
SERVICE PROVIDERS 2006
Source WHO
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TB / HIV CO-INFECTION
Egger M et al
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MEASURING IMPACT MALAWI
Initial decline in workplace mortality in one of
the largest employers after roll-out of
antiretroviral treatment
Source GFATM
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MEASURING IMPACT HAITI

• Global Fund-supported scale-up of AIDS and TB
  treament has led to
• Improved delivery of clean water, sanitation,
  vaccinations
• Improved primary healthcare indicators
• Four-fold increase in prenatal visits
• Improved staff morale and community participation

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POLICY AND ADVOCACY

• Encouraging investment in public goods
• Access to health as a human right

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