Treatment GuideJust DiagnosedSex & DatingAfrican AmericanStigmaAsk the HIV DocPrEP En EspañolNewsVoicesPrint IssueVideoOut 100
CONTACTCAREER OPPORTUNITIESADVERTISE WITH USPRIVACY POLICYPRIVACY PREFERENCESTERMS OF USELEGAL NOTICE
© 2024 Pride Publishing Inc.
All Rights reserved
All Rights reserved
By continuing to use our site, you agree to our Private Policy and Terms of Use.
In 2008, Reuben Granich and his colleagues at the World Health Organization published a paper in the medical journal The Lancet that proposed a new strategy for combating HIV in South Africa, a country staggered by the virus, with as much as 18% of the population estimated to be infected.
Based on a mathematical model, the study suggested a "test-and-treat" strategy. This would involve, among other steps, testing the entire population of South Africa for HIV and immediately beginning antiretroviral therapy for all who tested positive. The current standard of care calls for waiting until symptoms appear after diagnosis.
The test-and treat strategy, the authors suggested, could eventually lead to the elimination of HIV in South Africa within a decade. Since then, the utility and feasibility of this approach have been widely debated, and it remains the leading potential prevention strategy for South Africa.
One aspect of the proposal that has not been examined, however, is the strategy's full estimated cost. Now, researchers at the University of California, Los Angeles, have done their own modeling study and found that the costs have been substantially underestimated.
Reporting in the current online edition of The Lancet, Sally Blower, director of UCLA's Center for Biomedical Modeling and a member of the UCLA AIDS Institute, and Bradley Wagner, a postdoctoral scholar in Blower's lab, used their own sophisticated modeling techniques to duplicate the estimated cost curve used in the WHO report. They found that key potential costs — including the expense of annual testing for a population of 32 million, the implementation of prevention programs, and the "ramping up" of a health infrastructure that is currently overwhelmed — were not included in the proposed approach.
Because the WHO did not disclose what costs they included in their estimates, Blower says, the UCLA researchers reconstructed it on their own. Using their own mathematical modeling, the researchers devised a cost curve based only on treatment costs.
The WHO report assumed that the maximum cost of treating a patient with first-line drugs would be $1,163 a year, and treatment with second-line drugs — initiated when first-line therapy is no longer effective — would be $4,083 a year. The WHO authors also assumed that 97% of patients would need first-line drugs and 3% would need second-line drugs each year.
Using this information, and the estimated 4.5 million individuals who would, once identified, need treatment annually, the UCLA researchers constructed a maximum cost curve that, for the first five years after implementation, exactly matched the cost estimated by the WHO.
And that is the problem, Blower says.
"Their cost curves are only based on treatment costs," she says. "They do not include the costs of an annual testing program for the 27 million adults in South Africa who are currently uninfected, nor do they include the costs of the extensive prevention interventions that are necessary to reduce transmission."
Most importantly, they also do not include any costs for the tenfold scaling up in the health care infrastructure that would be necessary to reach the entire population, Blower adds.
"The health infrastructure in South Africa is at capacity now," Wagner says. "As a result, just reaching the entire population, many of whom live in remote rural areas in a country almost twice the size of Texas, would be hugely expensive and should be taken into account."
"Certainly, we should treat people who need it," Blower says, "but the costs of a universal test-and-treat strategy in South Africa have been substantially underestimated."
From our Sponsors
Most Popular
The science behind U=U has been liberating people with HIV for years
June 04 2024 3:31 PM
As Pride party season begins, the CDC urges mpox vaccinations
May 16 2024 6:52 PM
Exclusive: We kiki with Q from 'RuPaul's Drag Race'
June 24 2024 11:37 AM
The freedom of disclosure: David Anzuelo's journey through HIV, art, and advocacy
August 02 2024 12:21 PM
The Talk: Thriving with HIV
May 08 2024 10:45 AM
The Talk: What HIV isn’t
May 07 2024 10:48 AM
Activist and philanthropist Bruce Bastian dies at 76
June 26 2024 1:28 PM
In honor of Juneteenth 2024, meet The Normal Anomaly
June 19 2024 1:39 PM
Plus: Featured Video
Latest Stories
Check out our 2024 year-end issue!
October 28 2024 2:08 PM
Meet our Health Hero of the Year, Armonté Butler
October 21 2024 12:53 PM
AIDS/LifeCycle is ending after more than 30 years
October 17 2024 12:40 PM
Twice-yearly injectable lenacapavir, an HIV-prevention drug, reduces risk by 96%
October 15 2024 5:03 PM
How fitness coach Tyriek Taylor reclaims his power from HIV with self-commitment
September 19 2024 12:00 PM
Out100 Honoree Tony Valenzuela thanks queer and trans communities for support in his HIV journey
September 18 2024 12:00 PM
Kentucky bans conversion therapy for youth as Gov. Andy Beshear signs 'monumental' order
September 18 2024 11:13 AM
Why activist Raif Derrazi thinks his HIV diagnosis is a gift
September 17 2024 12:00 PM
Creator and host Karl Schmid fights HIV stigma with knowledge
September 12 2024 12:03 PM
Study finds use of puberty blockers safe and reversible, countering anti-trans accusations
September 11 2024 1:11 PM
Latinx health tips / Consejos de salud para latinos (in English & en espanol)
September 10 2024 4:29 PM
The Trevor Project receives $5M grant to support LGBTQ+ youth mental health in rural Midwest (exclusive)
September 03 2024 9:30 AM
Introducing 'Health PLUS Wellness': The Latinx Issue!
August 30 2024 3:06 PM
La ciencia detrás de U=U ha estado liberando a las personas con VIH durante años
August 23 2024 2:48 PM
Tratamiento y prevención del VIH por inyección: Todo lo que necesita saber
August 23 2024 2:41 PM
Sr. Gay World quiere asegurarse de que estés bien
August 23 2024 2:30 PM
Eureka is taking a break from competing on 'Drag Race' following 'CVTW' elimination
August 20 2024 12:21 PM
With a new case in Sweden, what is the new mpox outbreak and should you be concerned?
August 15 2024 4:48 PM