June 08, 2016
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UNAIDS initiative means ‘enormous’ benefits for South Africa

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An expensive and wide-reaching plan to end the AIDS epidemic in South Africa by 2020 would not only be hugely beneficial in fighting the disease, but also cost-effective, according to a recent modeling study published in the Annals of Internal Medicine.

The Joint United Nations Program on HIV/AIDS (UNAIDS) 90-90-90 initiative, which carries an estimated price of $54 billion over the next decade, aims to have 90% of HIV-infected South African citizens informed of their status, provide ART access to 90% of those HIV patients and to have 90% of ART recipients achieve viral suppression by 2020. The end result, according to a press release, would mean virologic suppression in 73% of all patients worldwide, up from a current estimate of about 29%.

“By every one of these measures, achieving the UNAIDS target strategy could have a transformative impact: averting millions of new HIV infections, saving millions of lives and tens of millions of years of life, and preventing millions of children from becoming orphans — and thereby curtailing the global epidemic,” Rochelle P. Walensky, MD, MPH, co-director of the Medical Practice Evaluation Center at Massachusetts General Hospital, and colleagues wrote.

The study made projections on the number of HIV transmissions, deaths, years of life saved, number of children orphaned by HIV and the cost-effectiveness of the initiative. At the current pace, the researchers projected 4.4 million new infections in the next 10 years, while the UNAIDS initiative would aim to limit new infections to 2.4 million. And while HIV is projected to kill 4.9 million people over the next 10 years at the current pace, the UNAIDS strategy would result in a projected 2.5 million deaths for the same period, according to researchers.

Walensky and colleagues reported that the annual average cost of care for patients undergoing ART was $930, which matched previous reports from South Africa. The funding for the program, which would require an additional $16 billion over 10 years, would yield an incremental cost-effectiveness ratio of $1,260 per year of life saved, they wrote.

“We found that if the 90-90-90 targets for diagnosis of HIV, receipt of ART, and virologic suppression can each be achieved in South Africa, enormous population and clinical benefits would follow,” the researchers wrote. – by Andy Polhamus

Disclosure: Walensky reports receiving grants from the NIH and is a member of the Scientific and Technical Advisory Committee of the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents, in addition to serving on the board of the HIV Medicine Association. Please see the full study for a list of all other authors’ relevant financial disclosures.