Cutbacks in international funds for HIV/AIDS prevention, treatment and research programs would save insignificant amounts of money and cause a devastating clinical and epidemiological impact, according to research published in Annals of Internal Medicine.
“During the late 1990s and early 2000s, global HIV programs enjoyed robust support and success in providing ART and HIV prevention activities to resource-limited settings,” Rochelle P. Walensky, MD, MPH, from Massachusetts General Hospital, and colleagues wrote. “In the past decade, however, funding has plateaued, suggesting donor fatigue and mounting political resistance worldwide ... Most recently, the U.S. government proposed cutting the U.S. foreign aid budget by one-third, affecting more than $6.7 billion currently earmarked for HIV/AIDS prevention, care and research.”
Walensky and colleagues sought to assess the clinical, epidemiologic and budgetary impact of alternative HIV program scale-back strategies in the Republic of South Africa and Côte d’Ivoire using the Cost-Effectiveness of Preventing AIDS Complications–International model. They compared the current standard described as CD4 count at presentation of 0.260 × 10 cells/L, universal ART eligibility and 5-year retention rate of 84% with alternative approaches to scaling back, including decreased HIV screening, no ART or delayed initiation when the CD4 count is less than 0.350 × 10 cells/L, reduced retention and no viral-load testing or second-line ART. They also evaluated published estimates of the HIV care continuum, ART efficacy and HIV-related costs for each country.
Results indicated that after 10 years, both projected HIV transmissions (ranging from 0.5% to 19.4%) and deaths (ranging from 0.6% to 39.1%) increased because of scale-back strategies. More than 500,000 additional cases of HIV and more than 1.6 million deaths could occur during the next 10 years in South Africa alone due to the cutbacks. Overall budgetary savings of up to 30% resulted from scaling back. In South Africa, approximately $900 in HIV-related outlays would be saved for every year of life lost, and in Côte d’Ivoire, about $600 to $900 would be saved when employing the least damaging and most effective scale-back alternatives for attaining budget cuts of 10% to 20%.
“To be clear, we are neither endorsing any of these painful choices nor excusing the political decisions that may make them necessary,” the researchers wrote. “But we show that assessing the clinical, epidemiologic and economic effects of alternative scale-back scenarios is possible and that some decisions made in response to the imposition of budget cuts will do less harm than others.” – by Alaina Tedesco
- Walensky RP, et al. Ann Intern Med. 2017;doi:10.7326/M17-1358.
Disclosures: Walensky reports receiving grants from NIH and Massachusetts general Hospital. Please see study for all other authors’ relevant financial disclosures.