Public HealthHIV prevention before HAART in sub-Saharan Africa
Section snippets
An effective prevention and treatment response
Two recent studies estimated the cost of an effective response.6, 7 One concluded that $9·2 billion would be needed annually.6 This estimate is roughly consistent with an earlier estimate of at least $7·5 billion annually.7 The higher figure of $9·2 billion represents 0·044% of the combined gross national product of the 22 wealthy donor countries constituting the Development Assistance Committee of the Organization for Economic Cooperation and Development (OECD).7 As indicated by their
How could money be best spent in the interim?
While the world debates how to achieve the full $9·2 billion needed, we need to decide how the next incremental contributions shall be spent.
A dominant theme heard from many policy makers and analysts is that treatment and prevention must go hand-in-hand. This rhetoric often fails to distinguish between treatment of opportunistic infections and palliative care, which is inexpensive and often highly cost effective,9 and HAART, which is both more costly and more effective. Combining the two under
Does prevention work?
HIV control efforts in Africa have centered on prevention since the beginning of the pandemic. Since incidence has increased dramatically, it would appear that spending more on prevention is a dubious choice. We believe that prevention programmes should be assessed more frequently and more rigorously. Some, such as mass communication and social marketing programmes, are particularly difficult to assess and others have not been assessed in a sufficient number of settings. Nevertheless, as
Limitations to the case for prevention
We recognise a number of limitations to this analysis. First, the analysis does not account for the value of pilot studies that assess the benefits, costs, and safety of delivering HAART in selected settings. This could have the important advantage of identifying the best means for delivering HAART in resource-poor settings. Thus, after expanded funding of prevention, HAART provision could be scaled up more rapidly, since best practices would already have been identified.
Second, we focus on the
Prevention and the rule of rescue
We believe other reasons exist to advocate the primacy of prevention. As the price drops, the pressure to spend money on HAART may become almost irresistible, for the best of humanitarian reasons. As will be discussed in more detail below, the “rule of rescue” dictates that more resources will be made available for identified sufferers than for present or future sufferers who are statistical abstractions. For this reason it is perhaps inevitable that more will be spent for treatment than is
But is it ethical?
There exists an ethical imperative based on principles of simple justice for the rich countries to mount an effective response to the HIV pandemic. This should include scaled-up prevention, treatment of opportunistic infections, care for the ill and for orphans, and the provision of HAART wherever and whenever this can be done safely. Based on the current actions of the OECD countries, it is sensible to assume that a fully scaled-up response is at least a few years away. It is also conceivable
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Evaluation of four chemotherapy regimens for treatment of advanced AIDS-associated Kaposi sarcoma in Kenya: a cost-effectiveness analysis
2022, The Lancet Global HealthCitation Excerpt :The finding that PLD would be cost-effective at a lower per-cycle price should inform price negotiations, as has been achieved in past negotiations of ART prices.42 In the early 2000s, there was reluctance to provide ART in LMICs due to cost and perceived complexity of implementation given limited infrastructure.43 However, advocacy from local and global communities coupled with evidence for ART feasibility and efficacy in LMICs led to reduced ART prices from $10 000 per person per year in 2000 to $100 per person per year in 2016.44
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