Transcript Presentation Title

Resource requirements for
reaching the treatment
goals under PEPFAR
XV International AIDS Conference
Bangkok
July 15, 2004
Owen Smith, Abt Associates Inc.
Gilbert Kombe, Abt Associates Inc.
Introduction and Objectives
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The President’s Emergency Plan for AIDS Relief (PEPFAR):
 PEPFAR targets
 Treat 2 million people with ARVs by 2008
 Prevent 7 million new infections by 2008
 Provide care to 10 million individuals by 2008
 Budget of $15 billion
 $10 billion of this is new money, of which $1 billion is for the
Global Fund; 55% of the remainder is ear-marked for
treatment
Key questions for study:
 Is the budget adequate for achieving the stated targets?
 What are the human resource requirements?
Findings can help inform policy decisions
Assumptions and Methods
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Assumed the goal of reaching 2 million on ARVs by 2008
is achieved in equal steps each year, starting in 2004
Calculations include drugs, monitoring tests, labor,
training, and capital
The cost of key supporting services is also included:
voluntary counseling and testing (VCT) and treatment of
opportunistic infections (OIs)
Some pediatric and 2nd line treatment included
Data was collected through primary sources in Uganda
and Zambia, interviews with providers, and from
international sources
Methods (continued)
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Per patient results indicate that drugs and
monitoring tests account for most costs;
labor,
training, and capital costs were small in
comparison
Therefore explored two scenarios:
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Low drug costs ($300 per patient on 1st line per year)
High drug costs ($600 per patient on 1st line per year)
Reaching targets within PEPFAR budget
Number of ARV patients under low and high drug cost scenarios
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
2004
2005
2006
Low Drug Costs
2007
High Drug Costs
2008
Human resource requirements
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As drug prices fall and donor funding rises, there is
increased focus on other potential obstacles to expansion
Quantifying financial needs is done frequently;
quantifying human resource needs is much less common
Explore two scenarios for the number of doctors
required to provide ARVs:
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90 minutes of doctor time per ARV patient per year
45 minutes of doctor time per ARV patient per year
Human resource requirements
Share of doctor workforce required to achieve PEPFAR goals
Human resource requirements
Share of doctor workforce required to reach full coverage by 2013
Conclusions
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Drug prices will be an important determinant of the feasibility of
reaching PEPFAR goals within the budget
The human resource constraint could be more important in certain
countries than the financial constraint; pursuing the many options
for improving HR capacity should be an urgent priority
Key uncertainties in ARV costing:
 Drug prices
 Rate of attrition to second line treatment
 Uptake of VCT services in a large-scale ARV program setting
 OI costs: reduced or delayed?
 Impact of ARV expansion on prevention efforts (long-term)
Thank you
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Partners for Health Reformplus project
USAID
Office of the Global AIDS Coordinator
Institute of Medicine (U.S.)
POLICY project