1. Ending AIDS in Kenya
new drugs and faster treatment
enrollment will cost effectively break
the back of the epidemic.

2. Rapid Steps to End AIDS in Kenya
New evidence has powerfully
demonstrated that we can halt
new infections.
HIV Prevention Trials Network study 052:
 Tested to see if ART can prevent HIV transmission
between couples where one partner is living with
HIV; and to determine when to initiate treatment.
 1,763 serodiscordant couples at 13 sites in Botswana,
Brazil, India, Kenya, Malawi, South Africa, Thailand,
the United States and Zimbabwe.
 The study arms compared immediate ART initiation at
or below 500 CD4 versus delaying till 350 CD4

3. Rapid Steps to End AIDS in Kenya
HPTN 052 results: earlier ART
initiation resulted in a
reduction in new infections.
 27 HIV transmissions occurred in the delayed
treatment arm.
 Only one infection happened in the early treatment
arm, and appears to have happened at ART initiation,
before ARVs could fully achieve viral suppression.
Myron S. Cohen et al, Prevention of HIV-1 Infection with Early Antiretroviral Therapy; N Engl J
Med 2011 365:493-505 August 11, 2011

4. Rapid Steps to End AIDS in Kenya
ART broadly benefits all of society
--and costs are declining.
• For every 1000
patient-years of
treatment provided:
• 228 people deaths averted
• 449 children not orphaned
• 61 sexual transmissions of
HIV averted
• 26 vertical (mother-to-child)
infections averted
• 9 TB cases averted among
HIV patients
• 2,200 life-years
gained.

5. Rapid Steps to End AIDS in Kenya
Treatment’s Broad Benefits to Society:
Cost savings from averted
Costs Savings Attributable to ART negative outcomes offset the
major portion of total treatment
$M180.4
$M280.6
Averted non-ART program costs.
treatment costs
Averted orphan care • Net estimated societal cost of
costs
treatment in 2011: $172 per
$M574.2 Averted sexual
transmissions discounted life-year gained.
$M614.9
Averted vertical
transmissions Based on WHO standards for
cost-effectiveness, ART is highly
cost-effective in most of sub-
Source: Center for Global Health
Division of Global HIV/AIDS
Saharan Africa.

6. Rapid Steps to End AIDS in Kenya
AIDS treatment more than pays for itself.
Hesch et al. (2011) compared treatment costs of 3.5 million people on ART supported by
the Global Fund against the benefits of restored productivity for people able to work
again, savings in unneeded orphan programmes, and averted costs for TB and other OIs.
• The financial saving of keeping these 3.5 million people alive and well would
amount to between 85% and 240% of programme costs.
2010 Kenya GDP per capita GDP: US$1,689
(Kshs 139,329) (World Bank PPP data)
Net estimated societal cost of treatment in
2011: $172 (Kshs 14,189) per discounted
life-year gained.
(Center for Global Health, Division of Global HIV/AIDS)
• By WHO standards for cost-
effectiveness, ART is highly cost-effective
in Kenya.
Resch S, Korenromp E, Stover J, Blakley M, Krubiner C, et al. 2011 Economic Returns to Investment in AIDS
Treatment in Low and Middle Income Countries. PLoS ONE 6(10): e25310. doi:10.1371/journal.pone.0025310

7. But there’s more.

8. Rapid Steps to End AIDS in Kenya
GAME CHANGING NEW DRUGS
• TAF – tenofovir pro-drug, just entered phase III trials:
• -Studies have shown decreased renal and bone metabolism
toxicity as compared to TDF
• -Can use 1/10 the mg dose - so potential for lower cost
• -May retain activity in the setting of some common TDF
mutations.
• DTG-finally an integrase inhibitor:
• -Most effective ART at bringing down VL rapidly
• -Theoretically cheap
• -Very potent - people don't fail often and
don't fail with mutations
• -Once daily
• -Increasing evidence for safety in kids

9. Rapid Steps to End AIDS in Kenya
Landmark 052 results are magnified
by CDC modeling of accelerating
treatment scale up.
 The current pace of ART scale-up in Kenya will continue to
incur rising costs, and is not sufficient to outpace new
infections.
 At the September PEPFAR
Scientific Advisory Board,
CDC presented a model
gauging the impact of
accelerating AIDS
treatment enrollment
in Kenya.

10. KENYA: With Accelerated Scale-Up, an
Additional 323,000 are Moved to Treatment from
Current Clinical Care and PMTCT
1,000
Thousands
900
800
700
600
500
400
300
200
100
-
2010 2011 2012 2013 2014 2015
Base Case Accelerated Scale-Up
Based on population estimates in the following priority populations: patients already in care with
CD4<500, PMTCT patients, HIV patients with active TB, known PLHA in sero-discordant couples 10

11. Accelerated Scale-Up Results in Annual Decline in New
HIV Infections – 31% by 2015
140,000
120,000
100,000
80,000
Accelerated Scale-up
Base Case
60,000
40,000
20,000
0
2010 2011 2012 2013 2014 2015
Under the base-case scenario, incident HIV infections remain relatively constant at or above
120,000 new cases per year. With accelerated treatment scale-up, incident HIV infections
could be driven down to ~86,500 by 2015. 11

12. Under Accelerated ART Enrollment, Significant Savings
Result Over Status Quo:
$800
Millions
$700
$600
$500
$400 Accelerated Scale-Up
Base Case
$300
$200
$100
$0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Estimated costs to maintain current coverage levels in the Base Case and Accelerated Scale-Up
Scenario. Flattened treatment costs in the accelerated scale-up scenario reflect effects of
declining HIV incidence and additional implementation efficiency. 12

13. Rapid Steps to End AIDS in Kenya
Treating more people faster has
dramatic benefits.
By quickly enrolling PLHIV above current
baselines of ART scale-up in Kenya, CDC
concluded that, by treating 900,000 by 2015:
 New infections would decline by 31% by 2015
 And costs are reduced below current
levels, up to 33%

14. Rapid Steps to End AIDS in Kenya
Treating more people faster is the
cheapest option.
Net costs=treatment costs minus costs averted:
• greatly reduced new infections
• medical costs for HIV-related illness and opportunistic infections
• orphan care
• sustained productivity for workers and families
• increasing service delivery efficiencies
• shrinking drug unit costs
• spill-over health systems benefits and synergies

15. Rapid Steps to End AIDS in Kenya
Kenya and Development Partners Must
Update Guidelines and Budget to Accelerate
Treatment Scale-up:
 Treat all serodiscordant couples regardless of CD4 as
per new WHO guidelines.
 Start the wheels in motion for new ARVs now!
 Lifelong ART for all pregnant/nursing women
nationwide—this year!!
 ART for all active TB patients
 Earlier Initiation at 500 CD4
 Greater use of viral load--comparable costs to CD4!

16. Rapid Steps to End AIDS in Kenya
Kenya and its Development
Partners must pay now,
or pay more later.
 Kenya must increase health spending health to comply with
PEPFAR Partnership Framework commitments by Treasury to
increase domestic health budgets by at least 10% annually
from 2010-2013.
 PEPFAR must sustain it’s funding commitments under the
Partnership Framework. We cannot reach six million by 2013
if OGAC breaks PPF commitments to Kenya.
 Donor countries must increase contributions to the Global
Fund. With Round 11 delayed, Kenya should lead other African
countries to call for an emergency replenishment conference
before the IAS in Washington.

17. Blueprint for an AIDS-
Free Generation:
• “UPFRONT costs associated w scaling up combo prevention are
substantial, but these investments do not result in ever-increasing
costs. in fact, the impact of up-front investments is a decline &
then a flattening of out-year costs, as fewer new services are
needed and the number of new infections falls substantially.”
• “PEPFAR is firmly committed to help countries move beyond the
tipping point”

18. TIPPING POINT:
when treatment
outpaces infections

19. Blueprint for an AIDS-
Free Generation:

20. Thank You Minister:
“To reap the full benefits of this year’s scientific breakthroughs, we
shall, together with our development partners, endeavour to put one
million people with HIV on treatment by the end of 2015, scaling up
from the current 460,000. This is a challenge that the country is
willing to tackle since its success will reduce the heavy disease
burden that the country has carried since the emergence of the HIV
epidemic. The additional resources Kenya is willing to commit to the
fight against HIV and AIDS will result in significant cost-savings later.”
“We believe that expanding HIV treatment to reach all Kenyans in
need is one viable way to both break the back of the HIV epidemic
and sustainably fund the fight against HIV.”
-Hon Minister of Special Programmes Esther Murugi