https://research-information.bris.ac.uk/ws/files/259213304/PIIS0140673620309259.pdf

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Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries

Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models.

Over the past few decades the world has witnessed the evolution of the HIV epidemic, from the initial reports on AIDS in 1982, through its rapid expansion with devastating global impacts, through the most recent period during which AIDS-related mortality and new infections among children have declined faster than new infections among adults [1]. At the SDG meeting in September 2015 the global community committed to ending the AIDS epidemic by 2030 [2], and at the High Level Meeting on HIV and AIDS in June 2016 this same community aimed to reduce new infections to less than 500,000 by 2020 [3]. Modelling analyses underlie these commitments, demonstrating that major reductions in HIV incidence and AIDS-related deaths by 80–90% are possible by 2030 [4]. The global community has taken a strong commitment to build on the past momentum and realise these goals. As we look ahead, many lessons are to be learned from the past AIDS response. Some of the major contributions over the past decade and a half of leadership, advocacy, financing, country ownership, partnerships, civil society, rights and social justice, science and data have already been highlighted recently [5]. Across this time frame, the AIDS response has grown in maturity and sophistication, built on robust collaboration and singular purpose. The science of HIV has grown and dramatically influenced our understanding of the impact of available interventions, and epidemiological and monitoring data have been a foundation of the entire response to the epidemic. Data on the changing epidemiology have been important to shape and target programmes to where HIV transmission is most intense and to leave nobody behind [6]. Programmatic data have served the ongoing management of specific responses and allowed for adaptation and realignment of the programmatic effort. In the aggregate, data have been instrumental to the progress, accountability and success of the entire global AIDS response. The HIV response has been able to translate commitments into funding, programmes and results. The current supplement aims to bring together papers on the approaches, indicators and data systems that have been used to monitor the AIDS response to date. The first two papers describe how UNAIDS (including WHO, UNICEF and other co-sponsors), and The Global Fund to fight AIDS, Tuberculosis and Malaria have defined indicators and designed data collection systems and reporting mechanisms to ensure accountability within their respective results frameworks and distil lessons for future monitoring [7, 8]. A second set of papers takes a country perspective on monitoring the AIDS response, covering Nigeria, Ukraine, and the United Kingdom [9–11]. Countries with different types of epidemics and different health systems have rightfully adapted the global frameworks to their local situation, providing a tailored system consistent with their epidemics. The ability to translate global commitments and targets into country accountability has been a critical part of the AIDS response. Topic-specific papers describe the monitoring of the care CASCADE, of programmes for the prevention of mother-to-child transmission, and of programmes for key & Peter D. Ghys Ghysp@unaids.org

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Monitoring the AIDS Response: How Can Lessons from the Pre-2015 Era Inform Monitoring Progress Towards Ending the AIDS Epidemic by 2030?

In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually-far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US$7.4Bn in low-income countries, US$8.2Bn in lower middle-income countries and US$10.5Bn in upper-middle-income-countries by 2020 before declining approximately 9% by 2030.

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Jose Antonio Izazola

Papers

What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach