HIV/AIDS Investment: Expensive but Effective

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A recent study, published in the Annals of Internal Medicine, revealed that although expensive, the UNAIDS "90-90-90" program is well worth the price. The program's overall goal is to be able to achieve a 73 percent reduction in the viral load to undetectable levels worldwide by 2020.

hiv 2Acquired immune deficiency syndrome (AIDS) has been responsible for 35 million fatalities since it was first recognized in 1981.  The initial infection with human immunodeficiency virus (HIV) is considered an epidemic that ranks with the influenza pandemic of the early 1900s and the Bubonic plague of the 14th century with regard to the number of deaths each caused. Not one area of the globe has been spared HIV’s wrath and it has caused tremendous human suffering and considerable economic and political strain. For these reasons combating this disease is an international priority.

In 2014 the United Nations Programme on HIV/AIDS (UNAIDS), launched what is known as the 90-90-90 program with three main objectives:

  • Diagnosing 90 percent of global HIV infections
  • Ensuring 90 percent of those infected receive antiretroviral therapy (ART)
  • Decreasing HIV viral load (a measure of disease burden) in 90 percent of those infected

The overall goal of this program is to be able to achieve a 73 percent reduction in the viral load to undetectable levels worldwide by 2020. Having an undetectable viral load does not mean a person has been cured of the disease, it simply means that the ART is working and it also significantly reduces the chances of disease transmission.

Researchers from the Massachusetts General Hospital (MGH), the University of Cape Town and the Yale School of Public Health conducted a study, published in the Annals of Internal Medicine, to estimate the clinical and economic value of reaching this goal while using South Africa as a “microsimulation model of HIV detection, disease, and treatment.”  It has been found that simulation modeling is a valuable and reliable tool to assist policy makers in the provision of healthcare.

The researchers utilized South African survey data on HIV transmission rates, fertility rates and costs of care for people currently infected as well as incident infections anticipated over the next 10 years.

The results of their study allowed the investigators to determine that through aggressive HIV detection methods, ensuring treatment with ART, scaling up treatment, adherence and retention, the benefits far outweigh the initial significant investment.

“Based on our findings, there is nothing overstated about the suggestion that 90-90-90 could lay the foundation for a healthier, more just and equitable world for future generations,” stated Rochelle P. Walensky, MD, MPH, of the MGH Division of Infectious Disease, who led the study. “Yes it would be expensive, but it would be worth every penny.”

According to a computer-simulation model, the authors found that the UNAIDS strategy would do the following over the next 10 years:

  • Avert about two million HIV transmissions
  • Prevent roughly 2.5 million deaths and 1.7 million orphans
  • Save over 13 million life-years

In addition to what is currently budgeted, over the next 10 years, the UNAIDS program would need a $16 billion cash infusion, but it would yield $1,260 per year of life saved.

“Implementation of 90-90-90 would represent a ‘virtuous circle’ of care, leading to earlier HIV diagnosis, more rapid treatment initiation, longer survival for HIV-infected persons, and fewer new cases of HIV transmission," said an encouraged Dr. Walensky. "The time to jump-start this worthy global undertaking is now.”