Long-Term Financing Needs for HIV Control in Sub-Saharan Africa in 2015-2050
estimate the present value of current and future funding needed for HIV
treatment and prevention in 9 sub-Saharan African (SSA) countries that account
for 70% of HIV burden in Africa under different scenarios of intervention
scale-up. To analyse the gaps between current expenditures and funding
obligation, and discuss the policy implications of future financing needs.
the Goals module from Spectrum, and applied the most up-to-date cost and
coverage data to provide a range of estimates for future financing obligations.
The four different scale-up scenarios vary by treatment initiation threshold
and service coverage level. We compared the model projections to current
domestic and international financial sources available in selected SSA countries.
In the 9
SSA countries, the estimated resources required for HIV prevention and
treatment in 2015-2050 range from US$98 billion to maintain current coverage
levels for treatment and prevention with eligibility for treatment initiation
at CD4 count of <500/mm(3) to US$261 billion if treatment were to be
extended to all HIV-positive individuals and prevention scaled up. With the
addition of new funding obligations for HIV-which arise implicitly through
commitment to achieve higher than current treatment coverage levels-overall
financial obligations (sum of debt levels and the present value of the stock of
future HIV funding obligations) would rise substantially.
upfront in scale-up of HIV services to achieve high coverage levels will reduce
HIV incidence, prevention and future treatment expenditures by realising
long-term preventive effects of ART to reduce HIV transmission. Future
obligations are too substantial for most SSA countries to be met from domestic
sources alone. New sources of funding, in addition to domestic sources, include
innovative financing. Debt sustainability for sustained HIV response is an
urgent imperative for affected countries and donors.
Below: Annual resources required by nine sub-Saharan countries (US$ billions) from 2015 to 2050 (3% discounting).
Below: Per capita annual resources required by nine sub-Saharan countries ($US) from 2015 to 2050 (3% discounting).
Below: Total expenditures on HIV
from domestic and international sources combined (current US$) in selected
sub-Saharan African countries, compared with estimated resource needs for
treatment, prevention and structural interventions in 2015 under different
coverage levels and eligibility for treatment. EAE, external AIDS expenditure;
GEA, Government Expenditure on AIDS; RNE, resource needs estimate. GEA and EAE
estimates are from Reschet al 2015.