One Person on ART
The lifetime cost to provide ART to a single person includes the cost of the ARV drugs as well as the costs of laboratory tests and service delivery for as long as the person survives on ART. The lifetime costs will depend on the effectiveness of ART in enhancing survival, prices for first and second line drugs, future costs of laboratory testing and service delivery, and the discount rate used to determine the present value of future expenditures. You can adjust any of the inputs in the 'Treatment Parameters', 'Cost Parameters', or 'Funding' tabs to vary these assumptions and see the impact on the total cost.
Because the CD4 category at which ART is initiated will affect the length of time on treatment, and therefore the associated costs, the CD4 category at which ART is initiated must be selected here to determine the lifetime cost of treatment for one person started on ART today.
The costs and length of time for one person on treatment will also vary according to the availability of second line therapy, which can be specified here as well.
The red column shows the total discounted cost summed over the lifetime of the individual. This represents the amount that would have to be set aside today to cover the costs of treatment for the lifetime of one person on ART.
The graph at the bottom shows the annual cost to maintain one person on ART. The top (blue) line shows the actual annual cost while the bottom (green) line shows the discounted costs.
Total on ART & Costs
The top graph displays the total number of people that are projected to be on ART in low- and middle-income countries from 2010 to 2025, disaggregated by first line therapy (FL) and second line therapy (SL), for the selected parameters chosen in the tabs on the right side of the screen.
The bottom chart displays the annual cost of HIV/AIDS treatment for the selected parameters. The bars for each year display the proportion of total costs that is spent on FL ARVs, SL ARVs, laboratory testing, service delivery, procurement, end of life care, and outreach/testing.
If the "no additional coverage" option is selected for population coverage in the 'Treatment Parameters' tab at the right, then this chart will display the costs of maintaining treatment for all of the people who were on ART at the end of 2009.
Note: The results in these graphs represent the total number on ART and associated costs according to the selected parameters, assuming full funding is available. For further information on actual funding levels, please see the 'Available Funding' display tab and the 'Funding' input tab.
Impact
The top chart displays the annual number of HIV-related deaths averted due to antiretroviral therapy for the selected treatment parameters; the cumulative number of deaths averted between 2010 and 2025 is displayed in the box.
The bottom chart displays the annual number of HIV infections which are averted due to antiretroviral therapy for the selected treatment parameters; the cumulative number of infections averted between 2010 and 2025 is displayed in the box.
Note: The results in these graphs represent the impact of ART according to the selected parameters, assuming full funding is available. For further information on actual funding levels, please see the 'Available Funding' display tab and the 'Funding' input tab.
Additionally, impact calculations for these charts compare the number of deaths averted and the number of infections averted each year from 2010 to 2025, based on the selected parameters, with a base case scenario in which ART was neither available historically (pre-2010) nor available in the future (post-2010).
Unmet Need
The top graph displays the unmet need for ART, or the number of people each year who are eligible for ART but are not receiving it, based on the eligibility criteria chosen in the 'Treatment Parameters' tab. The various colors indicate the proportion of the HIV-positive population eligible but not receiving ART who are in each CD4 category over time.
The bottom graph displays the number of people each year who are HIV-positive but who are not receiving antiretroviral therapy, including those individuals who are not currently eligible for ART. The various colors indicate the proportion of the untreated HIV-positive population who are in each CD4 category over time.
Note: The results in these graphs represent the unmet need for ART according to the selected parameters, assuming full funding is available. For further information on actual funding levels, please see the 'Available Funding' display tab and the 'Funding' input tab.
Funding
The top graph displays the total funding for ARV treatment that is currently available or pledged from 2010 to 2015. The different colors represent the individual contributions from the Global Fund, PEPFAR, UNITAID, national sources, and bilateral sources (international bilateral assistance), as well as an additional category for other sources of funding not included. These amounts can be adjusted from the default values in the 'Funding' input tab on the right.
The black line represents the total funding needed for ART, according to the selected parameters. The projected funding need will change as the ART scenario input parameters are modified in the 'Treatment Parameters' and 'Cost Parameters' tabs on the right.
The chart at the bottom indicates the annual funding shortfall, or funding gap, which is the difference between the funding needed based on the selected parameters and the funding that is currently available or pledged. This is the amount of additional funding required to support the projected number on ART.
Treatment Parameters
The model input parameters can be selected and modified in these tabs. Any input changes will impact the projection model and therefore modify all of the graphs and displays in the tabs on the left side of the screen. Using this split screen format, choose the output display tab of interest on the left side and then adjust the parameters in the input tabs on the right to evaluate the impact of varying treatment input parameters.
1. Select the level of population coverage: This specifies the total number of people who are eligible for treatment that will receive ART, including those that are already on treatment.
If the first option is chosen, treatment coverage will be scaled up from current levels to a specified percentage by 2015. The proportion of newly eligible individuals who are started on ART each year will then be maintained thereafter. The user can specify either a single target coverage for all individuals regardless of CD4 count or different target coverage levels according to CD4 category. If the 'single coverage level for all CD4 categories' option is chosen, the target coverage level should be specified in the box. If the 'different coverage levels specified by CD4 category' option is chosen, a pop-up window will appear which allows individual target coverage levels to be specified according to CD4 category.
If the second option is chosen, a specific number of individuals who are in need of ART will be put on treatment each year. The number of new individuals who will start ART each year should be specified in the box. If the 'annual number added' is greater than the number of individuals who are eligible for ART in a particular year, only those eligible for ART will initiate treatment, and the costing for ART treatment will reflect the number who actually start on ART, rather than the number who could theoretically start on ART.
If the third option is chosen, no additional people will be put on treatment. Therefore the projection model will calculate the impact and costs of maintaining only those people who are currently on treatment.
The default values assume either an 80% target by 2015 (Universal Access) for the single population coverage option or 1.2 million new people on treatment annually (based on the difference between number of people on ART between December 2008 and December 2009) for the population coverage option specifying the number of people who start on ART each year. For further information on ART coverage targets, please see:
Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, 2010 Progress Report. World Health Organization, UNAIDS, & UNICEF.
For further information on the ART 2015 coverage targets by CD4 category, please see:
Schwartlander B, Stover J, Hallett T, Atun R, Avila C, Gouws E, Bartos M, Ghys PD, Opuni M, Barr D, Alsallaq R, Bollinger L, de Freitas M, Garnett G, Holmes C, Legins K, Pillay Y, Stanciole AE, McClure C, Hirnschall G, Laga M, Padian N, on behalf of the Investment Framework Study Group (2011). Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 377(9782):2031-2041.
2. Select the treatment eligibility guidelines: This specifies the CD4 level at which the person becomes eligible for treatment. The current WHO guidelines recommend initiating ART when CD4 levels fall below 350 cells/microliter, and alternate scenarios in which treatment is initiated earlier at higher CD4 levels (when the CD4 levels fall below 500 cells/microliter, or when CD4 levels are higher than 500 cells/microliter) can be explored. The eligibility guideline must be specified for 2010, 2015, and 2020 and can vary, therefore the impact of changing eligibility levels at various time points can be evaluated.
The default values specify the current WHO guidelines using CD4<350 eligibility criteria for 2010, 2015, and 2020. For further information, please see:
Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach, 2010 Revision. World Health Organization.
3. Select the effectiveness of treatment: This specifies the annual probability of survival on ART depending on the CD4 level at which treatment is initiated. The survival rates are used to determine how long the person survives on first and second line therapy. The default values can be modified to explore the impact of increased or decreased baseline survival on ART. In addition, the impact of future improvements in survival on ART due to better treatment regimens or alternative survival data can be explored. The scaling factor in the box will increase or decrease survival on ART (based on the specified 2010 survival rates and percentage change in mortality) over a 5-year period between 2010 and 2015, and then maintain those levels thereafter.
Default values for 2010 survival rates on ART by CD4 category at treatment initiation are those utilized by the UNAIDS Epidemiology Reference Group using data from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) research consortium. The default mortality scaling factor is 100%, which assumes no change in survival rates on ART from 2010 to 2015.
4. Select the prevention program scenario: The number of new HIV infections projected by the simulation model is influenced by the level of prevention program activity in low- and middle-income countries. We have included two options for the impact of prevention programs, based on projections by the aids2031 project. If the current coverage option is chosen, current coverage levels of prevention programs are kept constant. If the rapid scale-up coverage option is chosen, then current prevention program coverage is scaled up to between 60% and 80% for the most cost-effective key interventions by 2015 and maintained at that level through 2025. These generally place a greater emphasis on prevention interventions targeted to higher risk groups (e.g. sex workers, men who have sex with men and injecting drug users) rather than those interventions targeted to the general population.
For more information on the coverage level assumptions for prevention programs in these two scenarios, see 'baseline' and 'hard choices' scenarios in:
Hecht R, Stover J, Bollinger L, Muhib F, Case K & D de Ferranti (2010). Financing of HIV/AIDS programme scale-up in low-income and middle-income countries, 2009-31. Lancet 376:1254-60.
Bollinger L, Stover J & S Forsythe. Estimating long-term global resource needs for AIDS through 2031. Glastonbury, CT: Results for Development Institute, Avenir Health, and the aids2031 Costs and Financing Working Group; 2009. Available at http://www.resultsfordevelopment.org/publications/estimating-long-term-global-resource-needs-aids-through-2031.
Cost Parameters
This tab is used to vary the costs associated with antiretroviral treatment. With the display tab of interest open on the left of the screen, the input values in this screen can be varied to evaluate the impact of changing prices on the costs of ART.
1. Adjust the annual cost of antiretroviral drugs: The annual cost of first and second line drugs can be varied independently. Prices can be specified for 2010, 2015, and 2020 to explore changing levels in antiretroviral costs over time.
The default values for 2010 are based on the weighted median price for the most commonly used FL regimens (including the lower priced d4T-containing regimens as well as the higher priced tenofovir-containing regimens) and the median price of the most commonly used SL regimens in low-income countries (in which 59% of patients on ART reside), lower-middle income countries (14% of ART patients) and upper-middle income countries (27% of ART patients). For more information on the pricing of ARV drug regimens and sources for these calculations, please see:
Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, 2010 Progress Report. World Health Organization, UNAIDS, & UNICEF.
Schwartlander B, Stover J, Hallett T, Atun R, Avila C, Gouws E, Bartos M, Ghys PD, Opuni M, Barr D, Alsallaq R, Bollinger L, de Freitas M, Garnett G, Holmes C, Legins K, Pillay Y, Stanciole AE, McClure C, Hirnschall G, Laga M, Padian N, on behalf of the Investment Framework Study Group (2011). Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 377(9782):2031-2041.
For more information on the WHO recommendations for first- and second-line drug regimens, see:
Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach, 2010 Revision. World Health Organization.
Note: New price reductions in antiretroviral drugs have recently been negotiated by CHAI, UNITAID & DFID which will reduce the cost of treatment for the 70 countries participating in CHAI's Procurement Consortium. For further information on these new prices, see:
http://www.clintonfoundation.org/files/chai_arv_ceilingPriceList_201105_english.pdf
2. Adjust the other antiretroviral treatment costs: Specify the cost of laboratory testing for new people starting ART, the annual cost of laboratory testing per person for continuing on ART, the annual cost of ART service delivery, the procurement costs (as a percentage of ARV drug costs), and the cost of end of life care. Prices can be specified for 2010, 2015, and 2020 to explore changing levels in costs associated with antiretroviral treatment over time.
For further information on ARV treatment costs, please see:
Schwartlander B, Stover J, Hallett T, Atun R, Avila C, Gouws E, Bartos M, Ghys PD, Opuni M, Barr D, Alsallaq R, Bollinger L, de Freitas M, Garnett G, Holmes C, Legins K, Pillay Y, Stanciole AE, McClure C, Hirnschall G, Laga M, Padian N, on behalf of the Investment Framework Study Group (2011). Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 377(9782):2031-2041.
Stover J, Bollinger L & Avila C (2011). Estimating the impact and cost of the WHO 2010 recommendations for antiretroviral therapy. AIDS Research and Treatment 2011, article ID 738271.
Menzies NA, Berruti AA, Berzon R, Filler S, Ferris R, Ellerbrock TV & Blandford JM (2011). The cost of providing comprehensive HIV treatment in PEPFAR-supported programs. AIDS 25:e-published ahead of print.
For further information on unit costs in the five country-specific PEPFAR costing studies (Botswana, Ethiopia, Nigeria, Uganda, and Vietnam), see:
The Cost of Comprehensive HIV Treatment in Botswana. The PEPFAR ART Costing Project Team, December 2009.
The Cost of Comprehensive HIV Treatment in Ethiopia. The PEPFAR ART Costing Project Team, October 2009.
The Cost of Comprehensive HIV Treatment in Nigeria. The PEPFAR ART Costing Project Team, December 2009.
The Cost of Comprehensive HIV Treatment in Uganda. The PEPFAR ART Costing Project Team, September 2009.
The Cost of Comprehensive HIV Treatment in Vietnam. The PEPFAR ART Costing Project Team, July 2009.
Note: Costs for the treatment of opportunistic infections (OI) have not been included in these calculations as reliable costing data on the treatment of OIs are not currently available. Also, although ARV treatment reduces the annual cost of OI treatment per person, the exact relationship between the two has not been determined. In addition, since ARV treatment increases survival, it may be that lifetime OI treatment costs for ARV patients are actually greater than for those not receiving ARV treatment.
3. Adjust the cost of testing: Provider-initiated testing and counseling (PITC) is used for those persons who make contact with the health care system either because they are symptomatic or for other reasons. Testing of most at-risk populations (MARP) includes commercial sex workers (CSW), men who have sex with men (MSM), and intravenous drug users (IVDU). Testing in programs preventing mother-to-child transmission (PMTCT) is usually considered as a separate funding stream, although the associated costs can be included in these projections, and includes the testing of pregnant women at antenatal clinic visits. General population HIV counseling and testing (HCT) includes those programs previously known as volunteer counseling and testing (VCT) as well as any other general population testing strategies.
The default values for testing costs are based on assumptions made by the aids2031 project. Provider-initiated testing and counseling is the same price as general population testing and counseling. Testing in PMTCT programs does not add any additional costs and testing of most at-risk populations only adds the cost of the test as these individuals are already being reached in prevention outreach programs. For more information on these assumptions, please refer to the following papers:
Bollinger L, Stover J & S Forsythe. Estimating long-term global resource needs for AIDS through 2031. Glastonbury, CT: Results for Development Institute, Avenir Health, and the aids2031 Costs and Financing Working Group; 2009. Available at http://www.resultsfordevelopment.org/publications/estimating-long-term-global-resource-needs-aids-through-2031.
Hecht R, Stover J, Bollinger L, Muhib F, Case K & D de Ferranti (2010). Financing of HIV/AIDS programme scale-up in low-income and middle-income countries, 2009-31. Lancet 376:1254-60.
4. Adjust the annual discount rate. The default discount rate is 3%.
Available Funding
Detailed information on the calculations, assumptions and references used to determine the current and projected default funding values can be found below:
GLOBAL FUND
2009: $1,351 million was disbursed by GF for HIV in 2009 [GFATM Innovation & Impact Report, March 2010] and 29% of all HIV expenditures through 2009 was spent on treatment [Making a Difference: Global Fund Results Report 2011]. We did not reduce this amount for money spent on pediatric ART as UNITAID covers a large proportion of pediatric ART (e.g., 75% of children in 40 developing countries), and PEPFAR has extensive coverage of pediatric ART as well.
2010: Overall, $3 billion was disbursed by GF to countries and programs in 2010 [Making a Difference: Global Fund Results Report 2011]. The total GF approved funding for 2002-2010 was $21.7 billion, with $12.0 billion (55%) approved for HIV; however, since 62% of cumulative country-level expenditures was spent on HIV by the end of 2009 [Making a Difference: Global Fund Results Report 2011], we assumed approximately 60% of the 2010 funding was for HIV. In addition, we maintained the assumption from 2009 that 29% of all HIV expenditures was spent on treatment [Making a Difference: Global Fund Results Report 2011].
2011-2013: $11.7 billion was pledged to GF for the period 2011-2013 at the Global Fund's Third Voluntary Replenishment Conference in 2010 [Making a Difference: Global Fund Results Report 2011]. We assumed the budget was split evenly across the three year period and, based on historical trends, that 60% of the pledged funding would be for HIV and 29% of this for treatment.
2014-2015: We assumed constant funding levels.
Note: The above figures for ART-specific funding include contributions to the Global Fund from PEPFAR and UNITAID.
PEPFAR
2009-2010: PEPFAR bilateral HIV/AIDS assistance (not including bilateral TB assistance or contributions to GF) was $5,503 million for FY 2009 and $5,542 million for FY 2010 [Making A Difference: Funding; PEPFAR October 2010]. Examining treatment spending alone in the FY 2009 budget shows that 35% of the overall PEPFAR budget (not including GF) was spent on adult and pediatric treatment [FY 2009: PEPFAR Operational Plan]. Given that both 8% of the total treatment budget was for pediatric treatment and 8% of those on ART were children, the proportion of the overall PEPFAR budget spent on adult treatment was 32%.
2011-2013: We assumed constant funding levels for bilateral PEPFAR funding during this 5-year authorization period (2009-2013).
2014-2015: We assumed constant funding levels for bilateral PEPFAR funding.
Note: The above figures are for bilateral PEPFAR ART funding only. ART-specific funds contributed by PEPFAR to the Global Fund are not added here as they are already included in the GF figures.
UNITAID
2009: UNITAID allocated $565 million to HIV/AIDS from its creation in 2006 through the end of 2009 [UNITAID 2009 Annual Report]. Of this, $235 million was given to CHAI for pediatric ART, $241 million to CHAI for adult SL ART or TFV-containing FL ART, $72 million was given for PMTCT programs with WHO/UNICEF, and $16 million was given for safeguarding the availability of ARVs with ESTHERAID. We assumed that approximately 50% of the $16 million for safeguarding ARV availability was spent on adult ARVs based on the roughly equal amounts given to CHAI for pediatric versus adult ART. Therefore we estimate that $249 million went to adult ART between 2006 and 2009, or 44% of the overall HIV/AIDS budget. Because 2009 expenditures were not available separately, we assumed the 2009 allocation was $86 million based on the 2010 budget for HIV/AIDS of $196.5 million [UNITAID website] and that 44% is spent on adult treatment.
2010: The UNITAID budget for 2010 is $407.9 million overall [UNITAID Resolution 4, 2010 Revised Budget, June 2010] and includes $196.5 million for HIV/AIDS [UNITAID website]. We assumed 44% of this is for adult ART based on the allocation in 2006-2009.
2011-2015: UNITAID is funded by the European airport tax. Travel & tourism is expected to double over the next 10 years [World Travel & Tourism Council: Progress and Priorities 2009-2010], so we assumed a 10% increase from 2010 levels each year.
Note: ART-specific funds contributed by UNITAID to the Global Fund are not added here as they are already included in the GF figures.
NATIONAL
This is domestic spending from public financing sources in low- and middle-income countries (LMIC).
2009: Antiretroviral therapy domestic spending from public financing sources for the 67 of 144 LMIC reporting most recent data through 2009 [UNAIDS Country Data 2010, AIDSInfo Database] is $1,285.3 million. This represents 57% of people on ART and 59% of people living with HIV in LMIC. Adding data on expenditures for Ethiopia, India, Malawi, South Africa, and Zimbabwe for 2009 [2010 UNGASS Country Reports] increased the proportion of the disease burden to 93% of people on ART and 95% people living with HIV in LMIC, bringing total domestic spending on ART from public financing sources to $2,005 million. This was adjusted to$2,120 million, based on the number of people living with HIV. Since 7% of those on ART are children [WHO & UNAIDS, Towards Universal Access 2010], we estimate that final domestic spending on adult ART is $1,971 million.
2010-2015: We assumed that growth in domestic public expenditure from LMIC will grow at the same rate as the average GDP. The 2010 GDP growth rate for emerging and developing economies was 7.3% and the projected GDP growth rate for 2011 and 2012 is 6.5% [IMF World Economic Outlook Report, 2011]. Because of China's rapid economic growth (projected GDP growth of 9.6% and 9.5% in 2011 and 2012, respectively) and relatively low HIV-related disease burden, we calculated the weighted GDP growth rate without China and used this figure (5.5%) for the rate of growth in domestic public expenditures in LMIC for 2010-2015.
Note: These figures include domestic spending by Brazil, Mexico, and Russia which pay relatively high prices for ARV drugs. If these three countries are removed, national domestic spending for LMIC would drop by 35%, from $1,971 million to $1,280 million.
BILATERAL
This is funding from high-income countries, excluding the United States/PEPFAR.
2009: OECD DAC bilateral HIV/AIDS commitments were $1,962.8 million ($6,997.8 million but excluding PEPFAR $5,035 million) [KFF/UNAIDS: Financing the Response to AIDS in Low- and Middle-Income Countries in 2009]. We assumed 30% was devoted to adult treatment (similar to the 30% GF and 32% PEPFAR proportions spent on adult treatment).
2010-2015: We assumed constant funding levels from 2010-2015.
Note: Although the unit cost per person on ART will vary historically between different funding organizations, we make the assumption that projected unit costs will be the same across the various organizations listed above beginning in 2010.
Universal voluntary Testing and Treatment (UvTT)
One strategy that has been proposed for the prevention of HIV transmission is Universal voluntary Testing and Treatment (UvTT), in which everyone in the population is tested annually for HIV and immediately given ART if found to be HIV positive. This projection model can be used to evaluate the potential impact of this strategy by adjusting the following input parameters:
1. Population target coverage set at 100% (preferable), although lower levels of coverage can be explored.
2. Treatment eligibility guidelines set at CD4>500. Although this does not exactly simulate the annual testing and immediate treatment advocated in the UvTT strategy, it will give an approximation of the number on treatment and associated costs.
3. The unit costs for outreach and testing should be substantially increased to approximate the higher overall expenditure with a general population testing strategy conducted on an annual basis.
For more information on the potential cost and impact of UvTT, please refer to the following articles:
Dieffenbach CW & AS Fauci (2009). Universal voluntary testing and treatment for the prevention of HIV transmission. JAMA 301(22):2380-2382.
Granich RM, Gilks CF, Dye C, De Cock KM & BG Williams (2009). Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 373(9657):48-57.
ART 2.0
ART 2.0 has recently been proposed as a new strategy for antiretroviral therapy in which highly effective standardized regimens are used, increasing survival and reducing the need for laboratory monitoring and service delivery visits. To explore the potential benefits and costs of the new paradigm outlined by UNAIDS using this projection model, the following parameters should be adjusted:
1. Annual survival on ART rates can be increased using the mortality scaling factor to increase the effectiveness of treatment by 2015. This can be done by decreasing the mortality scaling factor to approximately 50% (or less) such that mortality on ART is halved (or more).
2. The costs of first line therapy may decrease by 60% to 80% by 2025.
3. The laboratory, service delivery, and procurement costs may decrease by approximately 80% by 2025.
For more information on ART 2.0, please see the following publications:
Treatment 2.0: Is This the Future of Treatment? Geneva: UNAIDS; 2010.
Global Report: UNAIDS Report on the Global AIDS Epidemic 2010. Geneva: UNAIDS; 2010.
Schwartlander B, Stover J, Hallett T, Atun R, Avila C, Gouws E, Bartos M, Ghys PD, Opuni M, Barr D, Alsallaq R, Bollinger L, de Freitas M, Garnett G, Holmes C, Legins K, Pillay Y, Stanciole AE, McClure C, Hirnschall G, Laga M, Padian N, on behalf of the Investment Framework Study Group (2011). Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 377(9782):2031-2041.
Instructions for displaying the funding available to meet ART scale-up goals
1. Adjust the future funding levels from the default values, if desired, in the cells within the gray box above to represent projected or pledged funding.
2. Adjust the inputs in the 'Treatment Parameters' and 'Cost Parameters' tabs to simulate the desired ART scenario.
3. On the left side of the screen, in the 'Available Funding' tab, the graph at the top shows the funding available from each of the funding sources (solid colors) relative to the total funding needed (blue line), which depends on the selected treatment input and cost parameters in the tabs on the right.
4. The bar chart at the bottom of the 'Available Funding' tab on the left side of the screen shows the funding gap: the amount of additional funding required to support the projected number on ART.