GFATM the Global Fund to Fight AIDS TB and Malaria

Although great strides have been made in tackling HIV in recent years, Africa remains the continent most affected by HIV and progress towards ending AIDS is stalling. The COVID-19 pandemic, global inflation, growing debt levels, and a retreat from overseas development assistance by some donors are hampering Africa’s efforts to ramp up national HIV responses and are jeopardizing broader outcomes for health, social development and economic growth.

UNAIDS estimates that globally, low and middle-income countries will need investments of US$ 29 billion annually to meet targets of ending AIDS as a public health threat by 2030. In 2021, only US$ 21.4 billion was spent on HIV responses low and middle-income countries. 

In order to advance urgent and collaborative action to keep HIV high on political agendas and re-prioritize funding for health and HIV, African ministers of finance joined international partners on the sidelines of the World Bank / International Monetary Fund Spring meetings in Washington DC to explore ways to ensure financial sustainability of domestic HIV responses.

During the event, Ministers of Finance and senior representatives from Angola, Burundi, Democratic Republic of the Congo, Eswatini, Kenya, Lesotho, Nigeria, Mozambique, Rwanda, South Sudan, Tanzania and Uganda, and the Minister of Health of Côte d’Ivoire came together with global partners, including PEPFAR, the US Department of the Treasury, UNAIDS and the Global Fund to Fight AIDS, TB and Malaria.

Participants explored co-creating country-led paths towards the sustainability of the HIV response within broader health financing challenges. In the dialogue with Ministers of Finance, several issues were explored, among those, the need to overcome financing bottlenecks for HIV, expand local production of medicines and health technologies, or strengthen health systems and pandemics preparedness, while considering the relevance of developing joint HIV financial sustainability road-maps. 

The event, ‘Investing in Sustainable HIV Responses for Broader Health Security and Economic Resilience in Africa’, was moderated by Donald Kaberuka, Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the African Union’s High Representative for Financing, the Peace Fund and COVID-19 response. The event included remarks by;

• Alexia Latortue, Assistant Secretary for International Trade and Development, US Department of the Treasury,
• Dr. John N. Nkengasong, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, PEPFAR, US Department of State,
• Winnie Byanyima, Executive Director, UNAIDS, and  
• Symerre Grey Johnson, Head of Regional Integration Infrastructure and Trade, New Partnership for Africa's Development (AU/NEPAD)

Participants also reflected on the finding of the recently released report by the Economist Impact, supported by UNAIDS, titled A Triple Dividend: The health, social and economic gains from financing the HIV response in Africa. The report provided evidence showing that fully financing the HIV response to get back on track to achieve the 2030 goals will produce substantial health, social and economic gains in 13 countries in sub-Saharan Africa. 

This meeting was the first in-person discussion among ministers of finance and international partners around the sustainability of the HIV response held since COVID-19 travel restrictions were lifted. The meeting will be followed by a series of regional and in-country engagements to advance the financial, political and programmatic sustainability of the HIV response in preparation for the African Union’s Assembly of Heads of State Extraordinary Session on Ending AIDS by 2030.

High-income countries, private sector partners and developing countries, many with high HIV burdens, have all stepped up to fund the Global Fund  

NEW YORK/GENEVA, 21 September 2022—UNAIDS congratulates donors for increasing their contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Donors pledged US$ 14.25 billion to support efforts to end the three pandemics with more funding set to come. Donors made their pledges at the Global Fund’s Seventh Replenishment Conference hosted by the President of the United States Joe Biden.  

“Leaders from around the world who have committed resources today are life savers. They have made an investment in the future of children, young people and those facing the disproportionate burden of global inequalities—especially young women and girls. They are helping to build resilient health systems and be better prepared to face emerging threats to global security,” said Winnie Byanyima, Executive Director of UNAIDS.  

Countries rose to the challenge of increasing funding by 30%, demonstrating their confidence in the strong leadership of the Global Fund and its partners. The United States continued its position as a leader in global health by pledging US$ 6 billion, committing to invest US$1 billion for every US$ 2 billion pledged by the rest of the world. Canada, Germany, Ireland, Japan, Luxembourg, Portugal, Spain and South Africa all increased their funding by 30%. A notable contribution came from the Republic of Korea which increased its contribution by 300% to US$ 100 million.  

Developing countries, many tackling large HIV epidemics also stepped up in support of the Global Fund. Burkina Faso increased its contribution by 100%, Uganda and Togo increased by 50%, Kenya by 40% and Cote d’Ivoire by more than 30%. The Central African Republic, Eswatini, Malawi, Nigeria, Tanzania, Rwanda and Zimbabwe all made contributions to the Global Fund despite facing huge fiscal challenges, exacerbated by current global crises.  

“I am truly humbled to see so many developing countries, that are themselves facing multiple crises, and yet still made increased pledges to the Global Fund. I commend them,” said Ms Byanyima. 

France, the European Commission and the Bill and Melinda Gates Foundation all made important contributions to the Global Fund while Canada made an additional pledge of CAD 100 million for pandemic preparedness and called for increased financial contributions to UNAIDS and other partners working to end AIDS, TB and malaria. 

Two major donors are still to pledge, the UK and Italy, both of whom reiterated their support to the Global Fund and indicated they will be pledging in the coming weeks. UNAIDS urges them to match the 30% increase of their peers to get closer to the Global Fund US$ 18 billion target.  

This replenishment has mobilized the biggest global commitment to the Global Fund to date, in a context where challenging currency fluctuations made significantly increased contributions from European donors less visible when counting pledges in US dollars.  

UNAIDS congratulates Donald Kaberuka, Chair of the Global Fund Board and Peter Sands, Executive Director of the Global Fund. This achievement is a strong endorsement of their leadership of the Global Fund by member states and private donors, and of our collective efforts to fight AIDS, TB and Malaria.  

The HIV pandemic remains a global crisis claiming a life every minute but ending AIDS by 2030 is possible if countries continue to be bold in their financial contributions and work together to tackle inequalities. The actions needed to end AIDS will help protect the health and rights of everyone, strengthen economic development, and leave the world better prepared for future pandemic risks. 

UNAIDS will continue to work closely with the Global Fund in a joint effort to end AIDS. Since the creation of the Global Fund in 2002, UNAIDS has supported more than 100 countries in leveraging and implementing Global Fund resources—ensuring the funds are available and reach people most in need. 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) came together this week to co-host an event on the powerful partnership between the three organizations, countries and communities. The event, held on the sidelines of the 76th session of the United Nations General Assembly, highlighted the millions of lives saved through the partnership but warned that COVID-19 has hit hard and risks derailing efforts to end AIDS by 2030.

“We are in one of the most challenging moments in the history of HIV and global health,” said Winnie Byanyima, the Executive Director of UNAIDS. “We must act urgently. Our partnerships are strong and flexible and we must use what we have learned together to prevent a resurgent AIDS pandemic, to end inequalities and to tackle COVID-19.”

COVID-19 has had a hugely damaging impact on HIV services over the past 18 months. Peter Sands, the Executive Director of the Global Fund, said that the number of mothers receiving prevention of mother-to-child transmission of HIV services dropped by 4.5%, the number of people reached with HIV prevention programmes declined by 11%, HIV testing declined by 22% and voluntary medical male circumcision for HIV prevention dropped by 27%. “We were off track against our targets before COVID-19 hit and COVID-19 has knocked us further off track,” he said. “It’s going to be incredibly difficult to get fully back on track on HIV until we have got on top of COVID-19.” 

Widening inequalities due to COVID-19 were highlighted by the First Lady of Namibia, Monica Geingos, who joined Ms Byanyima in a live discussion from New York, United States of America. “After lockdown we are seeing a doubling of adolescent pregnancy rates, and we are assuming that new HIV infections among 15–24-year-olds will also increase,” she said. “When you remove children from a school environment, when you remove sex education you compromise education outcomes.” UNAIDS data show that if girls complete secondary education, it can reduce their risk of HIV infection by up to half in some countries.

Felix-Antoine Tshisekedi Tshilombo, the President of the Democratic Republic of the Congo and Chair of the African Union, joined the event with a powerful video message, saying, “We have been fighting HIV for 40 years and our successes and failures have taught us that we cannot conquer a pandemic without ending inequalities, promoting people-centred approaches while respecting human rights.”

The need for strong and continued partnerships to tackle both HIV and COVID-19 was strongly emphasized. Angeli Achrekar, the Acting United States Global AIDS Coordinator, who joined the event live in New York, said, “Nothing is possible without partnership. The partnership we have with PEPFAR, the Global Fund and UNAIDS is absolutely essential because we work hand in hand with countries and communities, the private sector and multilateral organizations to make things happen.”

The speakers urged bold political leadership, global solidarity and strategic partnerships that engage the people most affected by HIV. “What we need from governments is that they know that without us they cannot reach communities and achieve the ambitious goals,” said Sbongile Nkosi, the Co-Executive Director of the Global Network of People Living with HIV, who joined live from South Africa. “Governments must understand that we are the best allies in the response. We know the struggle, we know the solutions and we are committed to ending AIDS.”

The event was held at a landmark moment, 40 years since the first AIDS cases were reported and at the 25th anniversary of UNAIDS and the 20th anniversary of the Global Fund. “Forty years ago, a new virus emerged and sparked the HIV/AIDS pandemic,” said Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization. “Life-saving medicines were developed but the world’s poorest had no access to them and addressing this dire crisis of inequity took more than a decade. The multisectoral efforts often led by communities of people living with or affected by HIV were supported by unprecedented levels of international assistance from UNAIDS, the Global Fund and PEPFAR. Since then, millions of lives have been saved.”

There have been major successes in stopping new HIV infections among children and reducing AIDS-related deaths, but despite a 59% decline in AIDS-related deaths among children between 2010 and 2020, Omar Abdi, the Deputy Executive Director of the United Nations Children’s Fund, stressed that much more needs to be done. Just 54% of children living with HIV were accessing HIV treatment in 2020, compared to 74% of adults. “Ending AIDS in children needs our collective action to link the 1.7 million children living with HIV globally to HIV treatment to keep them healthy and alive. That’s why we are proposing a global framework to drive commitment and catalyse global action to end paediatric AIDS,” he said.

Usha Rao-Monari, the Associate Administrator of the United Nations Development Programme, highlighted the inequalities preventing key populations from accessing HIV services. She said that HIV services for key populations are “uneven or entirely absent” and underscored that key populations and their sexual partners account for 65% of new HIV infections worldwide, and for 93% of infections outside of sub-Saharan Africa. “Our work is absolutely not done,” she said. “Gender and other intersecting inequalities as well as punitive and discriminatory laws make people more vulnerable to HIV and hinder access to services. We need to address the inequalities that for decades have fuelled the spread of HIV.”

The hybrid event was a mixture of in-person discussions from the live venue in New York, video messages and live video link-ups from around the world. It was moderated from Nairobi, Kenya, by award-winning journalist Victoria Rubadiri, with live moderation of in-person discussions in New York by Regan Hofmann, Director, a.i., of the UNAIDS Liaison Office in Washington, DC, United States. 

The Global Fund to Fight AIDS, Tuberculosis and Malaria, the Government of Congo and health partners have announced two new grants worth more than US$ 64 million to strengthen prevention and treatment services to respond to HIV, tuberculosis and malaria and to build resilient and sustainable systems for health in Congo.

The two grants are a 97% increase from the previous allocation against the three diseases and will be spent from 2021 to 2023.

“UNAIDS looks forward to continuing to work closely with all partners to accelerate the elimination of vertical transmission of HIV and paediatric AIDS in Congo and to improve access to HIV/tuberculosis programmes, sexual and reproductive health, and legal services for young women and adolescent girls and all groups at higher risk of contracting HIV,” said Winnie Byanyima, Executive Director of UNAIDS.

The HIV grant will significantly increase the number of people living with HIV who know their HIV status and will expand access to life-saving antiretroviral therapy, particularly for pregnant women. In 2019 in Congo, only 51% of people living with HIV knew their HIV status and only 25% of people living with HIV were accessing antiretroviral therapy. Only 10% of pregnant women living with HIV in Congo were offered antiretroviral medicine to prevent the virus being passed to their babies.

The tuberculosis component of the grant aims to boost the national tuberculosis response, increase the notification of new tuberculosis cases and reach a 90% treatment success rate by 2023, in line with the World Health Organization’s End TB Strategy. The grant will also support the country’s efforts to improve treatment success for people with multidrug-resistant tuberculosis. The malaria grant will support the country’s goal to distribute 3.5 million mosquito nets by 2023 and expand access to quality malaria diagnostics and treatment tools.

“In the context of the country’s financial crisis, exacerbated by the COVID-19 pandemic, the grants allocated to Congo are a breath of fresh air. They provide renewed impetus to the government’s action in favour of populations affected by HIV, tuberculosis and malaria,” said the Prime Minister of Congo, Clément Mouamba.

The United Nations Development Programme will implement the HIV and tuberculosis grant, while Catholic Relief Services will implement the malaria grant.

Global partners that are committed to ending paediatric AIDS have come together to call on countries to rapidly scale up access to optimal, child-friendly HIV treatment for infants and children. The partners include the United Nations Children’s Fund, the World Health Organization (WHO), UNAIDS, the United States President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid, the Elizabeth Glaser Pediatric AIDS Foundation, and the Clinton Health Access Initiative (CHAI).

Children living with HIV continue to be left behind by the global AIDS response. In 2019, only 53% (950 000) of the 1.8 million children living with HIV (aged 0–14 years) globally were diagnosed and on treatment, compared to 68% of adults. [1] The remaining 850 000 children living with HIV have not been diagnosed and are not receiving life-saving HIV treatment. Two thirds of the missing children are aged 5–14 years and do not routinely attend traditional health facilities. Engaging communities and the families of people living with HIV, tuberculosis and other related diseases and offering family services are needed in order to find and start on treatment those missing children.

An estimated 95 000 children died of AIDS-related illnesses in 2019, in part due to lack of early diagnosis of HIV among infants and children and immediate linkage to optimal HIV treatment regimens. Untreated, 50% of infants infected with HIV during or around the time of birth will die before the age of two years. [1]

The United States Food and Drug Administration recently gave tentative approval for the first generic formulation of dolutegravir (DTG) 10 mg dispersible tablets. [2] This approval was the result of an innovative partnership between Unitaid, CHAI and ViiV Healthcare, together with generic suppliers, which accelerated the timeline of development by several years. The approval was quickly followed by the announcement on World AIDS Day of a groundbreaking agreement negotiated by Unitaid and CHAI that reduces the cost of HIV treatment by 75% for children in low- and middle-income countries, where the DTG 10 mg dispersible tablets will be available at a cost of US$ 4.50 for a 90-count bottle. [3] 

This now means that WHO-recommended, preferred first-line DTG-based antiretroviral treatment is now available in more affordable and child-friendly generic formulations for young children and infants as young as four weeks of age and weighing more than 3 kg. [4]  Rapid transition to this treatment, in combination with improved HIV diagnosis for children and other supportive measures, will help to urgently reduce the 95 000 preventable AIDS-related deaths in children.

DTG-based HIV treatment leads to better outcomes for children. DTG is less likely to be affected by drug resistance and achieves viral load suppression sooner; child-friendly dispersible tablets improve adherence due to a lower pill burden and being easier to administer. These factors help children achieve and maintain viral load suppression, the gold standard for measuring the effectiveness of HIV treatment. DTG-based treatment is the standard of care for adults. Starting on this regimen from infancy reduces the need for changes in treatment as they mature through childhood, adolescence and adulthood. Fewer regimens and regimen changes simplifies management of health care, improves stock management and reduces wastage. 

WHO has recommended DTG-based HIV treatment for all infants and children since 2018 [4] and provided dosing recommendations for infants and children over four weeks of age and more than 3 kg in July 2020. [5]

Suppliers have indicated their ability to meet global scale-up ambitions. Accurate forecasts of demand are critical to inform production planning and delivery timelines. It is therefore critical that national programmes start including DTG 10 mg dispersible tablets in their new procurement plans, review stocks and orders for existing non-DTG treatment for children, share forecasts with HIV treatment procurement partners and suppliers and place orders as early as possible.

The partners are committed to support national governments as they develop rapid transition plans from existing suboptimal HIV treatment to DTG-based treatment for infants and children, including advocacy for political commitment, mobilizing international and domestic resources, new policies and guidelines, managing medicine supply, distribution and stock, training health-care workers and sensitizing and engaging affected communities to ensure demand and treatment literacy for children living with HIV and their caregivers in order to ensure rapid uptake of these new formulations.

Further guidance for national programmes and partners is available from WHO. [5] The CHAI HIV New Product Introduction Toolkit has dedicated resources to help countries transition to paediatric DTG. [6]

Quotes from partners

“National governments, partners on the ground and affected communities need to work together to find and treat the children and infants whose lives can be saved by these new medicines,” said Shannon Hader, UNAIDS Deputy Executive Director for Programme. “The new medicines are cheaper, more effective and more child-friendly than current treatments for infants and young children. We need to get them into clinics to save lives now.”

“The United States President’s Emergency Plan for AIDS Relief works tirelessly to ensure clients can access the best available HIV treatment, including advanced, paediatric regimens for children living with HIV,” said Deborah L. Birx, United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy. “The accelerated introduction and expansion of paediatric DTG has the potential to save and improve the lives of thousands of children around the world. The United States President’s Emergency Plan for AIDS Relief will continue to collaborate with global and local partners to ensure the young children we serve can promptly access paediatric DTG.”

“Providing antiretroviral drugs to people living with HIV is at the core of our support to national HIV programmes,” said Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “This new and affordable child-friendly HIV treatment is a tremendous step forward that will improve and save the lives of some of the most vulnerable in society—young children infected with HIV. We are committed to support countries to make a fast transition to these new drugs.”

“Children in low- and middle-income countries often wait years to access the same medications as adults, hindering their quality of life, or even resulting in preventable deaths. We are proud to have worked with partners on this groundbreaking agreement that will bring quality assured dispersible DTG to children at a record pace,” said Philippe Duneton, Unitaid Executive Director. “Ensuring access to this treatment will transform the lives of children living with HIV, helping them to remain on treatment and saving thousands of lives.”

“For the first time, children living with HIV in low- and middle-income countries will have access to the same first-line antiretroviral medication at the same time as those in high-income countries,” said Iain Barton, Chief Executive Officer of the Clinton Health Access Initiative. “The partnership should serve as a model to remove barriers that hinder development of paediatric formulations to deliver top-line medications quickly and affordably.”

“The persistent treatment gap between adults and children prevents us from achieving an AIDS-free generation,” said Chip Lyons, President and Chief Executive Officer of the Elizabeth Glaser Pediatric AIDS Foundation. “Children living with HIV around the world urgently require age-appropriate, effective and accessible formulations. Approval of dispersible DTG is a momentous step forward, but meaningless if this new formulation doesn’t quickly reach the babies and small children who desperately need it most. The Elizabeth Glaser Pediatric AIDS Foundation is committed to supporting accelerated roll-out, uptake and delivery of new, optimal paediatric antiretroviral medicines in partnership with global, regional and local leaders.”

“The persisting treatment gap between mothers and children is unacceptable with the new scientific breakthroughs that are within our reach to change the trajectory”, said Chewe Luo, Associate Director and Chief of HIV, United Nations Children’s Fund. “The United Nations Children’s Fund welcomes global commitments and progress made in developing better diagnostic approaches and optimal regimens for children to improve their outcomes.”

“This has the potential to be a true game-changer for children with HIV", said Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes at WHO. “We must do all in our power to help countries get this new paediatric DTG 10 mg to all the children who need it."

[1] UNAIDS. Start Free Stay Free AIDS Free - 2020 report. 07 July 2020. https://www.unaids.org/en/resources/documents/2020/start-free-stay-free-aids-free-2020-progress-report

[2] https://www.accessdata.fda.gov/drugsatfda_docs/pepfar/214521PI.pdf

[3] UNITAID press release. Groundbreaking Agreement Reduces by 75% the Cost of HIV Treatment for Children in Low-and Middle-Income Countries. https://unitaid.org/news-blog/groundbreaking-agreement-reduces-by-75-the-cost-of-hiv-treatment-for-children-in-low-and-middle-income-countries/#en 

[4] World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV. Interim guidance. 1 December 2018, https://www.who.int/publications/i/item/WHO-CDS-HIV-18.51.

[5] World Health Organization. Considerations for introducing new antiretroviral drug formulations for children. Policy brief. 1 July 2020, https://www.who.int/publications/i/item/9789240007888.

[6] Clinton Health Access Initiative. HIV new product introduction toolkit. Pediatric 10 mg dispersible, scored resources, https://www.newhivdrugs.org/.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.