New plan to com­bat Aids is costly, ‘but worth it’

CityPress - - News - ZINHLE MAPUMULO zinhle.mapumulo@city­press.co.za

South Africa could have an Aids-free gen­er­a­tion as early as 2026 – if it can pump more re­sources into pre­vent­ing and treat­ing HIV, a new study has found.

The study, con­ducted by re­searchers from Univer­sity of Cape Town and Yale Univer­sity in the US, found that a UN pro­gramme on HIV/Aids, known as 90-90-90, has the po­ten­tial to sig­nif­i­cantly in­crease sur­vival, re­duce the num­ber of chil­dren or­phaned by HIV and con­tain the global Aids epi­demic within the next 10 years.

Launched two years ago, the goal of 90-90-90 is to achieve vi­ral sup­pres­sion – by re­duc­ing the vi­ral load to an un­de­tectable level – among 73% of HIV-in­fected peo­ple world­wide by 2020. It is cur­rently es­ti­mated that 24% of those with HIV have achieved vi­ral sup­pres­sion.

To meet this goal, the pro­gramme fo­cuses on three ar­eas: di­ag­nos­ing 90% of HIVin­fected per­sons world­wide; link­ing 90% of iden­ti­fied cases to an­tiretro­vi­ral ther­apy (ART); and achiev­ing vi­ro­log­i­cal sup­pres­sion among 90% of ART re­cip­i­ents.

Re­searchers used South African epi­demi­o­log­i­cal data and re­sults from HIV screen­ing and treat­ment pro­grammes to gauge the likely ef­fect of 90-90-90 in South Africa, and com­pared it with the cur­rently pro­jected pace of HIV de­tec­tion and treat­ment over the next five and 10 years.

Us­ing a com­puter-sim­u­la­tion model, the team has found that over the next decade, 90-90-90 would avert more than 2 mil­lion new HIV in­fec­tions, more than 2.4 mil­lion deaths and over 1.6 mil­lion or­phans. It could also save an ad­di­tional 13 mil­lion pa­tien­tyears of life, com­pared with the cur­rent pace of screen­ing and treat­ment roll-out. At a glance, this seems like an am­bi­tious plan.

But se­nior study au­thor David Paltiel, a pro­fes­sor at Yale School of Pub­lic Health, be­lieves it is pos­si­ble. “We are con­vinced, based on the re­sults of our anal­y­sis, that the suc­cess­ful im­ple­men­ta­tion of the 90-90-90 tar­gets would have a trans­for­ma­tive im­pact on the Aids epi­demic world­wide,” he said. The 90-90-90 model has al­ways been sold as the best ini­tia­tive to end the Aids epi­demic. But crit­ics are con­cerned about its suc­cess­ful global im­ple­men­ta­tion, say­ing it would re­quire un­prece­dented cash in­fu­sions from donor or­gan­i­sa­tions. How­ever, South Africa is proof that it can be done. The coun­try has the largest HIV treat­ment pro­gramme in the world, with more than half (3.3 mil­lion) of the peo­ple es­ti­mated to be HIV pos­i­tive (6.4 mil­lion) re­ceiv­ing an­tiretro­vi­ral treat­ment. Although the coun­try is still bat­tling with new HIV-in­fec­tion rates, it has dras­ti­cally re­duced Aids-re­lated deaths by en­sur­ing that those who need treat­ment have it, and more peo­ple have been put on treat­ment within a short pe­riod. This was also noted by the study au­thors, who felt that the strides made by South Africa in re­cent years could be used as an ex­am­ple to halt and re­verse the HIV tide if coun­tries fol­lowed 90-90-90. Study co-au­thor Linda-Gail Bekker of the Des­mond Tutu HIV Cen­tre and Univer­sity of Cape Town said: “Our goal was to ad­dress that con­cern, pro­vid­ing donors and part­ner coun­tries with prag­matic es­ti­mates of what 90-90-90 will cost and what re­turns they can ex­pect on that in­vest­ment.” The pro­gramme would cost $54 bil­lion (R815 bil­lion) over the next 10 years for the whole world’s in­fec­tions – a 42% cost in­crease over cur­rent scale-up ac­tiv­i­ties. But as a whole, the study found that in­vest­ment in 90-90-90 would yield a cost-ef­fec­tive­ness ra­tio of $1 260 a year of life saved, and a ra­tio sim­i­lar to that of HIV treat­ment, the au­thors said. Dr Rochelle Walen­sky of the Mas­sachusetts Gen­eral Hospi­tal’s di­vi­sion of in­fec­tious dis­ease, and a study co-au­thor, ac­knowl­edged the huge ex­pense, but said: “It would be worth every penny.”

Linda-Gail Bekker

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