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The Global Fund experience and the social research agenda

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Buenos Aires. MILLENNIUM DEVELOPMENT GOALS. MDG 1: Eradicate extreme poverty and hunger ... Buenos Aires. 2000: Okinawa G8 ; Millennium Development Goals ... – PowerPoint PPT presentation

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Title: The Global Fund experience and the social research agenda


1
Access
Hope
Michel D. Kazatchkine, M.D. The Global Fund
to Fight AIDS, Tuberculosis and Malaria 22 July,
2007
2
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

3
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

4
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
5
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
6
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

7
AIDS Estimated total annual resources available
19962005
UA goal
3by5
PEPFAR
8
GLOBAL FUND 3,000 LIVES SAVED EVERYDAY
9
NUMBER OF PEOPLE RECEIVING ART IN LOW AND MIDDLE
INCOME COUNTRIES, 2002-2006
Source WHO/UNAIDS
10
COMPARATIVE TREATMENT OUTCOME
Source M. Egger et al, ARTLINC
11
PREVENTION AND TREATMENT
  • Prevention and treatment mutually reinforce
    each other and are now considered as part of an
    integrated approach to care

12
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

13
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

14
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

15
GLOBAL RESOURCE NEEDS
Source UNAIDS
16
VERTICAL EQUITY IN HEALTH CARE-RELATED OUT OF
POCKET PAYMENTS (Bamako )
17
DRUG PRICES FIRST LINE
Source MSF July 2007
18
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
19
COUNTRIES WITH CRITICAL SHORTAGES OF HEALTH
SERVICE PROVIDERS 2006
Source WHO
20
TB / HIV CO-INFECTION
Egger M et al
21
MEASURING IMPACT MALAWI
Initial decline in workplace mortality in one of
the largest employers after roll-out of
antiretroviral treatment
Source GFATM
22
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

23
POLICY AND ADVOCACY
  • Encouraging investment in public goods
  • Access to health as a human right

24
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