US aid cuts to HIV might cost lives with­out much sav­ings

New study warns fund­ing cut­backs would lead to new in­fec­tions and more deaths

Business Daily (Kenya) - - TOP NEWS -

Re­duc­ing US for­eign aid for HIV preven­tion and treat­ment might not save that much money in the long run, and it could lead to a surge in new in­fec­tions and fa­tal­i­ties, a new study sug­gests.

A US bud­get pro­posal to re­duce for­eign aid by one-third would af­fect more than $6.7 bil­lion cur­rently ear­marked for HIV/ Aids re­search, preven­tion and treat­ment, re­searchers note in the An­nals of In­ter­nal Medicine, on­line

Au­gust 28.

In South Africa alone, cut­backs could re­sult in more than 500,000 ad­di­tional cases of HIV and more than 1.6 mil­lion more deaths within the next decade, re­searchers es­ti­mate.

At most, the pro­posed bud­get cuts would save just $600 to $900 for ev­ery year of life lost in South Africa and the Ivory Coast, re­searchers es­ti­mated, be­cause any ini­tial sav­ings would lead to high costs down the line to treat more peo­ple in­fected with HIV.

“This is not an epi­demic we can kick down the road and think it will go away,” said lead study au­thor Rochelle Walen­sky, an in­fec­tious dis­ease re­searcher at Har­vard Med­i­cal School and Massachusetts Gen­eral Hos­pi­tal in Bos­ton.

“Loss of in­vest­ment now will mean big­ger prob­lems and price tags later,” Dr Walen­sky said by email.

To as­sess the po­ten­tial im­pact of for­eign-aid cuts on the global ef­fort to com­bat HIV, re­searchers com­pared cur­rent stan­dards for start­ing an­tiretro­vi­ral ther­apy and keep­ing peo­ple on the drugs to what might oc­cur with fewer re­sources.

Re­searchers looked at cost data from the Repub­lic of South Africa and the Ivory Coast to see what might hap­pen in each coun­try if HIV screen­ing was re­duced, ac­cess to med­i­ca­tion was lim­ited to the sick­est pa­tients, ac­cess to al­ter­na­tive drugs when ini­tial treat­ments don’t work was elim­i­nated, and lab tests to mon­i­tor pa­tients and ef­forts to keep peo­ple in long-term treat­ment were cut back.


They es­ti­mated how much money could be saved by each of these moves, how many new in­fec­tions and deaths would oc­cur, and how many ad­di­tional years of life would be lost.

Ex­ist­ing com­mit­ments to pa­tients al­ready re­ceiv­ing care for HIV in­fec­tion would re­strict over­all sav­ing to no more than 30 per cent, the re­searchers es­ti­mated. As cur­rently pro­posed, the US for­eign-aid bud­get cuts would not re­duce care for peo­ple al­ready on treat­ment.

Over time, those sav­ings would dry up, as the in­crease in HIV trans­mis­sions would lead to ac­cu­mu­lat­ing costs for the care of those pa­tients, the re­searchers con­clude.

One lim­i­ta­tion of the study is that re­searchers don’t know what changes would ac­tu­ally be made to HIV preven­tion or treat­ment based on the pro­posed US for­eign-aid cuts.

Even so, the anal­y­sis of­fers a pre­view of what could hap­pen after cut­ting back in­vest­ment in HIV preven­tion and treat­ment, said Ar­leen Lei­bowitz, a public pol­icy re­searcher at the Uni­ver­sity of Cal­i­for­nia, Los An­ge­les, who wasn’t in­volved in the study.

“Early an­tiretro­vi­ral treat­ment has a dou­ble ben­e­fit - it im­proves health and sur­vival of the HIVin­fected per­son, but also cuts down on trans­mis­sion,” Lei­bowitz said by email. “This, in turn, will re­duce lon­grun costs.”

When newly in­fected pa­tients start an­titretro­vi­rals quickly, they can be­come non-con­ta­gious within two to three months, noted Eric Goosby of the Uni­ver­sity of Cal­i­for­nia, San Fran­cisco School of Medicine.

“The drop in the num­ber of in­fec­tions cre­ates less util­i­sa­tion of clin­ics, emer­gency ser­vices and in­pa­tient ser­vice, thereby sav­ing money,” Goosby, who wasn’t in­volved in the study, said by email.

Cut­ting back in HIV in­vest­ments now would re­verse ex­tra­or­di­nary gains made in sav­ing lives and re­duc­ing new HIV in­fec­tions, said Diane Havlir, chair of the Unaids Sci­ence and Tech­nol­ogy Ad­vi­sory Com­mit­tee.

“Such pull­backs would en­sure we would pass on HIV epi­demic for gen­er­a­tions to come,” Dr Havlir, who wasn’t in­volved in the study, said by email.


Mean­while US Pres­i­dent Don­ald Trump’s plan to cut for­eign aid sup­port­ing HIV/AIDS treat­ment could cost one mil­lion years of lost life in South Africa and Ivory Coast, ac­cord­ing to a just-re­leased global study re­leased.

In the first study to mea­sure the im­pact of cuts in global in­vest­ment in HIV care in terms of health and costs, sci­en­tists found sky-rock­et­ing deaths in the African na­tions would far out­weigh sav­ings.

South Africa has the high­est preva­lence of HIV world­wide, with 19 per cent of its adult pop­u­la­tion car­ry­ing the virus in 2015, ac­cord­ing to Unaids, with a to­tal of seven mil­lion Hiv-in­fected peo­ple.

Ivory Coast counted 460,000 Hivin­fected peo­ple in that same year.

Trump’s pro­posed bud­get for 2018, made public in May, en­vi­sions cuts to the Pres­i­dent’s Emer­gency Plan for Aids Re­lief (PEPFAR) pro­gramme, a corner­stone of US global health as­sis­tance, which sup­ports HIV/AIDS treat­ment, test­ing and coun­sel­ing for mil­lions of peo­ple world­wide.

Un­der Trump’s bud­get, which pur­sues his “Amer­ica First” world view, PEPFAR fund­ing would be $5 bil­lion per year com­pared to about $6 bil­lion an­nu­ally now, the US State Depart­ment has said. No pa­tient cur­rently re­ceiv­ing an­tiretro­vi­ral ther­apy, a treat­ment for HIV, through PEPFAR funds will lose that treat­ment, of­fi­cials have said.

Should the cuts keep South Africans and Ivo­rians from re­ceiv­ing an­tiretro­vi­ral drugs, an ad­di­tional 1.8 mil­lion Hiv-in­fected peo­ple would die over the next 10 years, 11 re­searchers in Amer­ica, Europe and Africa con­cluded, us­ing math­e­mat­i­cal mod­els.


The com­bined deaths amount to nearly nine mil­lion years of life lost, the sci­en­tists cal­cu­lated, in what they said was the first ef­fort to put fig­ures on the pro­posed cuts.

The re­searchers mea­sured ex­pected sav­ings over the next decade, whose small scale they said raised ef­fi­cacy and eth­i­cal ques­tions. In South Africa, it would amount to some $900 per year of life lost, com­pared to $600 to $900 in Ivory Coast.

“We leave it to read­ers to draw their own con­clu­sions about whether im­pos­ing such trade-offs on vul­ner­a­ble pop­u­la­tions ac­cu­rately reuf­b02ects how donor coun­tries value life in re­cip­i­ent na­tions,” the re­searchers wrote in An­nals of In­ter­nal Medicine.

Sav­ings would even­tu­ally dry up over the decade, they found, due to higher costs tied to the spread of HIV amid scaled back screen­ing and care.

“Would the rel­a­tively small sav­ings re­alised by cur­rently pro­posed bud­get re­duc­tions be worth these large hu­man­i­tar­ian costs?” said lead au­thor Rochelle Walen­sky, a pro­fes­sor of medicine at Har­vard Med­i­cal School.

“Over the past decade and a half we’ve spent con­sid­er­able money to save lives in these and other African na­tions.”

Some 90 per cent of Ivory Coast’s fund­ing for HIV care and preven­tion de­pends on in­ter­na­tional aid, while South Africa self-fi­nances most of its HIV ex­pen­di­tures, ac­cord­ing to US gov­ern­ment fig­ures.


BAT­TLE FOR LIFE Ac­tivists march through the streets of Dur­ban, South Africa, dur­ing the 21st In­ter­na­tional Aids Con­fer­ence in July 2016.

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