14 January 2013

How Cost Effective is Treatment As Prevention of HIV?

It turns out that using ARV treatment to prevent the spread of HIV between partners is cost effective as defined by WHO guidelines, but is less so than other interventions like medical male circumcision.
Till Barninghausen, David Bloom and Salal Humair have recently published the results of such a modeling exercise for South Africa, assessing “whether TasP is indeed a game changer or if comparable benefits are obtainable at similar or lower cost by increasing coverage of medical male circumcision (MMC) and antiretroviral treatment (ART) at CD4 <350 a="a" href="http://www.pnas.org/content/early/2012/12/05/1209017110.abstract" microliter="microliter" see="see">here
, gated). The authors find that MMC is significantly cheaper than TasP in terms of cost per infections averted – $1,096 versus $6,790. Further, they find that most benefits result from high levels of ART coverage using the CD4 <350 blockquote="blockquote" criteria.="criteria." microliter="microliter" nbsp="nbsp">
Barninghausen et al conclude that the most cost-effective HIV prevention strategy in South Africa is first to increase MMC coverage, and then to scale up ART: this strategy would achieve comparable incidence reductions to TasP and cost $5 billion less, a figure comparable to total Global Fund expenditures on AIDS over a five year period.
Read Amanda Glassman's full explanation on the CGD blog and the paper here. She argues that the research is important given the challenges of financing HIV interventions. Getting to zero new infections will involve utilizing the most cost-effective interventions.