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The prevention benefits of expanded AIDS treatment: how large, how affordable?

The prevention benefits of expanded AIDS treatment: how large, how affordable?. The new era in HIV/AIDS treatment and prevention: science, implementation and finance Wilton Park Meeting Geneva, Switzerland 27 – 28 June 2012. Robert Hecht, Managing Director. Main Messages.

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The prevention benefits of expanded AIDS treatment: how large, how affordable?

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  1. The prevention benefits of expanded AIDS treatment: how large, how affordable? The new era in HIV/AIDS treatment and prevention: science, implementation and finance Wilton Park Meeting Geneva, Switzerland 27 – 28 June 2012 Robert Hecht, Managing Director

  2. Main Messages • The population-level prevention effects of expanded treatment are not fully understood – but modeling suggests that these could be significant. • In a high prevalence setting like South Africa, treatment efforts to date -- as imperfect as they have been – appear to have reduced new infections by 15-30% over the past six years. • Broadening treatment will lower new infections further – the South African government’s current expanded effort and a Universal Test and Treat program could cut infections by an additional 26% over a decade. • Rapidly expanded treatment in South Africa will double ART costs over the next five years. This is large but affordable. The cost of universal test and treat would more severely strain the country’s fiscal capacity. • Coupling expanded ART with other proven prevention interventions could achieve additional reductions in new infections.

  3. Treatment as prevention in ahigh prevalence setting Estimated impact of AIDS treatment on incidence, South Africa 2006-11 Source: Eaton et al., 2012

  4. What would be the impact of expanded treatment in the coming years? We modeled three scenarios for South Africa: • Current Practice (CP): individuals access ART after symptoms show, CD4 < 350 cells/mm from 2011, 15% drop out in first year • Expanded Effort (EE): individuals tested every two years; ART initiated @ CD4 ~ 350; effective linkage to care, 4% drop-out rate • Universal Test and Treat (UTT): 90% receive an AIDS test every year, initiation immediately after testing positive, 2% drop-out rate

  5. The number of ART patients would grow significantly under EE and UTT

  6. Annual infections would also fall substantially Year

  7. How much would it cost? Cost of annual treatment scale up 2-3X in first five years Cost over 10 years (USD billion) $ 30.5 $ 19.3 $ 13.7

  8. How affordable would rapid ART scale-up be? 2011 status quo: • ART = ZAR 7.8 billion (US$ 0.93 billion) • 63% of total national AIDS spending • 8% of government health budget 2015 projected costs for each scenario, South Africa

  9. Expanded treatment plus other prevention could further lower new infections – KZN province

  10. Issues for discussion • What are the likely prevention gains from implementing current ART guidelines in high prevalence settings? • What are the financial implications in these extreme settings, especially for governments in middle income countries (e.g., South Africa), for donors in low income countries (e.g., Mozambique)? • How should national leaders regard the benefits, costs, and feasibility of a more aggressive UTT approach, logistically and financially? • How far could a combination of scaled up ART and other cost-effective prevention services go in blunting the epidemic in Southern Africa?

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