Preparing for the Future of HIV/AIDS in Africa A Shared Responsibility (2011) / Chapter Skim
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2 The Future Impact of Current Decisions
2 The Future Impact of Current Decisions
Pages 22-41
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From page 22... ...
• A plausible "best" scenario for 2020 projects the total number of patients on treatment to reach 7 million in Africa and the annual expenditures for treatment to total approximately $7 billion. • Under several plausible scenarios, treatment costs will eventually decline as a proportion of the health budgets of African countries, enabling them to move toward greater ownership of their countries' prevention, treatment, and care objectives.
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From page 23... ...
The committee's quantitative estimates of burden in this chapter and Appendix A focus on HIV prevalence as an indicator of the total health burden, on the total number of patients on treatment, on the total spending required to sustain treatment, and on spending as a share of projected national health expenditures. Chapter 4 considers in more depth the burden of HIV prevalence on the health sector in African states.
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From page 24... ...
However, there is an urgent need to make these assays more sensitive and specific so that accurate estimates of incidence will be available to medical and policy leaders. Evidence of What Works from Randomized Controlled Trials Experimental evidence on successful HIV prevention interventions is limited.
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From page 25... ...
, a potential cofactor of HIV. BOX 2-1 Results of Community Randomized Controlled Trials of Interventions for Sexually Transmitted Infections In Mwanza, Tanzania, syndromic management of STIs led to significantly (42 per cent over 2 years)
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From page 26... ...
Even when controlling for initial prevalence, however, there appears to be no relationship between expenditure and the scale of reductions in prevalence. Figure 2-1 shows that there is no discernible association between HIV/AIDS prevention spending per person and the degree of improvement in HIV prevalence among young people.
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From page 27... ...
Figure 2-2 shows the results of a model constructed by the committee that assumes optimistically that the uptake rate of 30 percent of unmet need for treatment attained in 2007–2009 is sustained at WHO's new definition of need, 3 but with no additional prevention success, while donor support for treatment increases. For 2020, this model projects about 20 million people on treatment (Panel a)
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From page 28... ...
Expenditures ART % Pub HE ART % Total HE Cost of second-line Total cost of ART as portion of total 60 40 30 40 20 20 Percentages 10 Billions of U.S. dollars 0 0 2010 2020 2030 2040 2050 2010 2020 2030 2040 2050 FIGURE 2-2 Assuming increased donor support for treatment without additional prevention, the committee projects for 2020 about 20 mil million people on treatment and treatment costs alone of about $15 billion.
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From page 29... ...
Under these assumptions, increased donor support for treatment leads to 22 million on treatment at an annual cost of about $15 billion in 2020, about the same burden as in Figure 2-2 without the success of male circumcision, but the longer-term prospect is improved. As can be seen in Panel b of Figure 2-3, the impact of enhanced prevention is to slowly reduce the annual number of new infections until in 2030, it is less than the number of deaths from AIDS, and the number of people living with HIV/AIDS begins to decline.4 As a result of the momentum of the 27 million people surviving on treatment in 2030, the cost of HIV/AIDS treatment only levels off in absolute terms, but it does begin to decline after 2030 relative to projected African governments' health expenditures.
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From page 30... ...
Expenditures Cost of second-line ART % Pub HE ART % Total HE Total cost of ART as portion of total 60 25 20 40 15 10 20 Percentages 5 Billions of U.S. dollars 0 0 2010 2020 2030 2040 2050 2010 2020 2030 2040 2050 FIGURE 2-3 Even with male circumcision and the transmission-reducing effects of treatment, increased donor support for treatment leads to 22 million on treatment at an annual cost of about $15 billion in 2020, but the numbers living with HIV/AIDS begin to decline in 2030.
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From page 31... ...
Expenditures Cost of second-line ART % Pub HE ART % Total HE Total cost of ART as portion of total 60 20 15 40 10 20 Percentages 5 Billions of U.S. dollars 0 0 2010 2020 2030 2040 2050 2010 2020 2030 2040 2050 FIGURE 2-4 Given increased donor support and major prevention efforts, the committee projects reduced treatment need and reduced costs in 2050.
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From page 32... ...
The only positive note is that total costs are likely to decline as a proportion of total government health spending, on the assumption that African economies grow at the 4 to 5 percent rates that are projected for the next several years (The World Bank, 2010)
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From page 33... ...
Infections and deaths Total number on ART New HIV infections Number of AIDS deaths Number of adults with Number living with HIV/AIDS unmet need for ART 6 70 15 5 60 4 50 10 3 40 5 New infections 2 30 Number living with Millions of people HIV/AIDS (Millions) or deaths (Millions )
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From page 34... ...
Beyond the impact of behavior changes already observed, there might be benefits of expanding prevention efforts. Using interventions with observed effi cacy in improving either HIV incidence or intermediate outcomes, we can calculate the predicted impact of prevention interventions, including high coverage of counseling and testing and adult male circumcision.
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From page 35... ...
. Exploring the relationship among viral load and transmissibility, CD4 count, and period from infection to different CD4 counts, we can calculate the expected proportion of new HIV infections generated by infectious individuals before they start treatment.
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From page 36... ...
Over the longer term, the reduced treatment failure seen with early treatment could reduce the numbers of deaths and increase years of life saved. The optimum time for treatment initiation will therefore depend on the horizon over which benefits are calculated and the discounting that is used to weigh future costs and benefits against current costs and benefits.
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From page 37... ...
ART can reduce HIV transmission both directly (by reducing viraemia and thereby HIV transmissibility) and indirectly (by reducing risk behavior among those diagnosed, counseled, and treated and by diffusing attitudes and norms among the population that facilitate a general acceptance of the problem of HIV/AIDS and changes in risk behavior)
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From page 38... ...
2007. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial.
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From page 39... ...
1995. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: Ran domised controlled trial.
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From page 40... ...
2010. Association of highly active antiretroviral therapy cover age, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: A population-based study.
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From page 41... ...
2010. Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics.
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