Abstract
Shortages of human resources for treating HIV/AIDS (HRHA) are a fundamental barrier to reaching universal antiretroviral treatment (ART) coverage in developing countries. Previous studies suggest that recruiting HRHA to attain universal ART coverage poses an insurmountable challenge as ART significantly increases survival among HIV-infected individuals. While new evidence about ART’s prevention benefits suggests fewer infections may mitigate the challenge, new policies such as treatment-as-prevention (TasP) will exacerbate it. We develop a mathematical model to analytically study the net effects of these countervailing factors. Using South Africa as a case study, we find that contrary to previous results, universal ART coverage is achievable even with current HRHA numbers. However, larger health gains are possible through a surge-capacity policy that aggressively recruits HRHA to reach universal ART coverage quickly. Without such a policy, TasP roll-out can increase health losses by crowding out sicker patients from treatment, unless a surge capacity exclusively for TasP is also created.
Highlights
During the past decade, major progress has been made in enrolling HIV-infected people in antiretroviral treatment (ART) programs
Our first main result (Fig 3) is that if the number of human resources for treating HIV/AIDS (HRHA) in South Africa stays constant at the current level, ART coverage will rise rather than decline over time, unlike the result indicated in previous studies [5, 22]
The reason for this finding was that better survival due to increasing ART coverage made universal coverage a moving goalpost that would become harder to reach with every forward step; each 10% increase in ART coverage would require more human resources than required for the previous 10% increase in ART coverage [5]
Summary
Major progress has been made in enrolling HIV-infected people in antiretroviral treatment (ART) programs. Sub-Saharan Africa exemplifies this progress, where approximately 9 million people received ART in 2013 [1] compared with 100,000 in 2003 [2]. HIV treatment has become one of the largest coordinated programs in the history of global public health, large ART coverage gaps remain. In many countries in sub-Saharan Africa, one in two persons urgently needing life-saving ART under the current ART-eligibility guidelines still does not receive treatment [2]. Attaining universal antiretroviral treatment (ART) coverage for HIV-infected ART-eligible people is a central goal of global HIV efforts. The last decade’s global HIV response has substantially addressed shortages of drugs, equipment, and facilities in many developing countries
Published Version (Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have