The Challenge
In 2011, 34 million people around the world were living with HIV, 1.7 million died from the disease, and an additional 2.5 million people were newly infected. Antiretroviral therapy (ART) for HIV slows the progression of the disease, allowing people to live longer, support their families, and contribute to their communities. However, the aggregate cost of sustaining ART treatment is large and rising. An estimated $18.9 billion was spent on HIV treatment, care, and support in low- and middle-income countries in 2012. It is critical to find ways to make treatment as affordable and efficient as possible, and to continue improving HIV prevention so that fewer people become infected.
The Opportunity
Recent research suggests that AIDS treatment also has important prevention benefits. ART reduces the amount of the HIV virus in a person’s body, thereby dramatically decreasing the likelihood of transmitting HIV to others. It is now important to answer the remaining questions surrounding ART, such as how soon after becoming HIV-positive an individual should commence treatment, how much it would cost to expand ART to larger numbers of infected people in high-prevalence countries, whether a “test and treat” approach would be cost-effective, and whether low-income countries in Africa and Asia could afford such programs.
Our Work
To help answer these questions, R4D teamed with Imperial College London to develop an analysis, entitled “The Prevention Benefits of Expanding AIDS Treatment: How Large and How Affordable Are They?,” which was presented at the Wilton Park Conference in June 2012. Focusing on South Africa, the authors sought to estimate the population-level prevention impact, cost, and affordability of expanded ART.
The study, supported by Gilead Sciences, found that in South Africa, treatment efforts to date may have reduced new infections by 15-30% over the past six years. If the South African government continues to expand ART, the number of new infections could fall by an additional 26%. While such expanded treatment could double ART costs over the next five years, fiscal space analysis suggests that the required incremental spending is affordable for the South African government, without external funding. However, other high-prevalence countries with lower per-capita income, such as Zambia or Mozambique, might require additional financial assistance to pay for broader AIDS treatment.
The study also found that more aggressive ART alone would be unlikely to end the AIDS epidemic in these countries. To achieve that end, a combination of prevention activities, including medical male circumcision, prevention of mother-to-child transmission, and targeted behavior change interventions for high risk groups, will also be needed.
Photo: A hospital in Entebbe, Uganda. The International AIDS Vaccine Initiative (IAVI) works with partners to advocate for the development of preventive AIDS vaccines as an essential component of a comprehensive response to the HIV pandemic. © International Aids Vaccine Initiative
