title: Towards an improved investment approach for an effective response to HIV/AIDS.
abstract: Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system. Our framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV/AIDS. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than US$22 billion. Implementation of the new investment framework would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches, and result in 29·4 million life-years gained. The framework is cost effective at $1060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone.
authors.affiliation: Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. schwartlanderb@unaids.org
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schwartländer
authors.forename: John
authors.initials: J
authors.lastname: Stover
authors.forename: Timothy
authors.initials: T
authors.lastname: Hallett
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.forename: Carlos
authors.initials: C
authors.lastname: Avila
authors.forename: Eleanor
authors.initials: E
authors.lastname: Gouws
authors.forename: Michael
authors.initials: M
authors.lastname: Bartos
authors.forename: Peter D
authors.initials: PD
authors.lastname: Ghys
authors.forename: Marjorie
authors.initials: M
authors.lastname: Opuni
authors.forename: David
authors.initials: D
authors.lastname: Barr
authors.forename: Ramzi
authors.initials: R
authors.lastname: Alsallaq
authors.forename: Lori
authors.initials: L
authors.lastname: Bollinger
authors.forename: Marcelo
authors.initials: M
authors.lastname: de Freitas
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Garnett
authors.forename: Charles
authors.initials: C
authors.lastname: Holmes
authors.forename: Ken
authors.initials: K
authors.lastname: Legins
authors.forename: Yogan
authors.initials: Y
authors.lastname: Pillay
authors.forename: Anderson Eduardo
authors.initials: AE
authors.lastname: Stanciole
authors.forename: Craig
authors.initials: C
authors.lastname: McClure
authors.forename: Gottfried
authors.initials: G
authors.lastname: Hirnschall
authors.forename: Marie
authors.initials: M
authors.lastname: Laga
authors.forename: Nancy
authors.initials: N
authors.lastname: Padian
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D003906:Developing Countries; D005380:Financing, Government; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D007391:International Cooperation; D010154:Pakistan / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology