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British Columbia Centre for Excellence in HIV/AIDS. What can we learn from the impact of dramatically scaling-up treatment on future costs and prevention efforts?. Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS vlima@cfenet.ubc.ca.

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Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS vlima@cfenet.ubc

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British Columbia

Centre for Excellence

in HIV/AIDS

What can we learn from the impact of dramatically scaling-up treatment on future costs and prevention efforts?

Viviane Dias Lima

British Columbia Centre for Excellence in HIV/AIDSvlima@cfenet.ubc.ca


Rationale Evidence

  • MTCT (De Cock 2000; Coovadia 2009)

  • PEP (Pinkerton 2004, Fisher 2006)

  • Discordant Couples (Quinn 2000; Castilla 2005; Wawer 2005; Bechange 2008; Garnett 2008)

  • Population-based studies (Fang 2004; Lima 2007; Anema 2009)

  • Mathematical Models (Blower 2000; Law 2001; Abbas 2006; Montaner 2006; Lima 2007-2009; Granich 2009; De Cock 2009)

HAART stops HIV replication

HIV levels fall to undetectable in blood as well as in sexual fluids

Sharp reduction in HIV transmission


Evidence from British Columbia


Lima V JID 2008

Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 2008; 198:59-67


ex at the age of 20 years: 23.6 years

Direct cost to treat each person with first-line therapy: $15,400 CAN

Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 2008; 198:59-67


Return on increased investment resulting from status quo approach versus 50% and 75% expansion scenarios

Lima V JID 2008


Current global ARV need


Number of people receiving antiretroviral drugs in low- and middle-income countries (2002 - 2007)

UNAIDS & WHO 2008


UNAIDS & WHO 2008


Funding gap between resource needs and resource availability

(2005-2007)

Needs

Availability

UNAIDS & WHO 2008


Effect of PEPFAR on HIV Incidence


Lima 2009


Where do we go next?


Scaling-up ART: Needs & Constraints

→ Cost (direct & indirect)

→ Limited Resources - How to prioritize the available funds?

→ Treatment Guidelines - When to start?

- 1st & 2nd Line Therapy?

- Laboratory Monitoring

→ Treatment of Co-morbidities & other Health Issues

→ Long-term Sustainability: Health Systems & Funding

→ Other Concurrent Prevention Efforts

→ Social & Gender Inequalities

→Cultural & Governmental Barriers

→Human Rights Issues


Thanks!


Other slides


Effect of PEPFAR on HIV Incidence


Lima 2009


Current global ARV need


UNAIDS & WHO 2008


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