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HIV treatment scale-up affordable in most countries with projected resources

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Scaling up HIV treatment in Zambia, Rwanda and Swaziland would be affordable if there is no decline in resources, but efforts in Malawi would require additional resources, according to data presented at AIDS 2014.

“Scaling up HIV treatment under the 2013 WHO Guidelines will have a significant impact on the epidemic, but there is a lack of evidence on the resources required for implementation,” researchers from the Clinton Health Access Initiative wrote in the study abstract. “Our results illustrate that if programs ran efficiently and there was no significant decline in available resources for HIV, scale-up should be affordable in three of four countries.”

The researchers developed an epidemiological model to estimate the number of deaths, new HIV infections and the distribution of patients by disease stage. The determined the effects of different scenarios, models of care, retention rates and testing treatments on costs to scale up treatment in Malawi, Rwanda, Swaziland and Zambia.

They found that the cost for universal access to treatment and care, testing, male circumcision and condoms in 2020, as per the 2013 WHO Guidelines, would account for less than 60% of the projected resources for HIV for Rwanda, Swaziland and Zambia, but the costs were higher than the expected resources for Malawi. When compared with 2010 guidelines, the incremental cost of universal access under the 2013 guidelines ranged from 5% in Swaziland to 21% in Malawi.

These numbers account for expected changes related to treating a higher number of less complex patients, such as task shifting and multiple month prescriptions.

“Costs from current HIV programs are not generalizable given the increasing number of patients who are not yet experiencing symptoms,” the researchers said. “Ministries of Health require additional evidence to make decisions about how and when to increase eligibility and coverage. Overall, these data support a shift in policy debates from whether to scale up treatment to how to do so in the most efficient manner.”

For more information:

Tagar E. #WEAE0105LB. Presented at: 20th International AIDS Conference; July 20-25, 2014; Melbourne, Australia.