Abstract
BackgroundAntiretroviral Treatment (ART) significantly reduces HIV transmission. We conducted a cost-effectiveness analysis of the impact of expanded ART in South Africa.MethodsWe model a best case scenario of 90% annual HIV testing coverage in adults 15–49 years old and four ART eligibility scenarios: CD4 count <200 cells/mm3 (current practice), CD4 count <350, CD4 count <500, all CD4 levels. 2011–2050 outcomes include deaths, disability adjusted life years (DALYs), HIV infections, cost, and cost per DALY averted. Service and ART costs reflect South African data and international generic prices. ART reduces transmission by 92%. We conducted sensitivity analyses.ResultsExpanding ART to CD4 count <350 cells/mm3 prevents an estimated 265,000 (17%) and 1.3 million (15%) new HIV infections over 5 and 40 years, respectively. Cumulative deaths decline 15%, from 12.5 to 10.6 million; DALYs by 14% from 109 to 93 million over 40 years. Costs drop $504 million over 5 years and $3.9 billion over 40 years with breakeven by 2013. Compared with the current scenario, expanding to <500 prevents an additional 585,000 and 3 million new HIV infections over 5 and 40 years, respectively. Expanding to all CD4 levels decreases HIV infections by 3.3 million (45%) and costs by $10 billion over 40 years, with breakeven by 2023. By 2050, using higher ART and monitoring costs, all CD4 levels saves $0.6 billion versus current; other ART scenarios cost $9–194 per DALY averted. If ART reduces transmission by 99%, savings from all CD4 levels reach $17.5 billion. Sensitivity analyses suggest that poor retention and predominant acute phase transmission reduce DALYs averted by 26% and savings by 7%.ConclusionIncreasing the provision of ART to <350 cells/mm3 may significantly reduce costs while reducing the HIV burden. Feasibility including HIV testing and ART uptake, retention, and adherence should be evaluated.
Highlights
After over 30 years, we still find ourselves struggling to address a Human Immunodeficiency Virus (HIV) pandemic in which over 30 million people have died [1] [2]
HIV infections and deaths are reported in nominal values, without discounting
Our baseline findings represent the potential impact of best practice HIV testing and Antiretroviral Treatment (ART) programs
Summary
By the end of 2010, 6.6 million people were on antiretroviral treatment (ART), but 7.6 million in need lacked access, and in 2010 there were an estimated 2.7 million new HIV infections [3] [4] [5]. Without substantial improvements in prevention, we are unlikely to meet access targets for life-saving ART with a projected 47.5 million cumulative HIV infections by. More recently randomized controlled trials on the use of preexposure prophylaxis (PrEP) and ART to prevent HIV transmission in serodiscordant couples have provided positive results [14] [15,16,17] and the overall situation has increased interest in the potential prevention role of ART [18,19]. We conducted a cost-effectiveness analysis of the impact of expanded ART in South Africa
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
