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