Transcript Slide 1

British Columbia
Centre for Excellence
in HIV/AIDS
What can we learn from the
impact of dramatically scaling-up
treatment on future costs and
prevention efforts?
Viviane Dias Lima
British Columbia Centre for Excellence in HIV/AIDS
[email protected]
Rationale
Evidence
HAART stops HIV replication  MTCT (De Cock 2000; Coovadia 2009)

 PEP (Pinkerton 2004, Fisher 2006)
HIV levels fall to undetectable  Discordant Couples (Quinn
in blood as well as in sexual 2000; Castilla 2005; Wawer 2005;
Bechange 2008; Garnett 2008)
fluids
 Population-based studies

(Fang 2004; Lima 2007; Anema 2009)
Sharp reduction in HIV
transmission
 Mathematical Models (Blower
2000; Law 2001; Abbas 2006; Montaner
2006; Lima 2007-2009; Granich 2009; De
Cock 2009)
Evidence from British Columbia
Increase HAART Coverage
from 50% to 75%
Increase HAART Coverage
from 50% to 75%
1200
Drirect Drug Cost (CAN$ per 100,000)
500
Number of New Infections
450
400
`
350
300
Lima V JID 2008
250
1995
2005
2015
2025
2035
1100
1000
900
800
700
600
500
400
2000
2010
2030
2040
Year
Year
No intervention
3 years uptake
2020
Immediate uptake
6 years uptake
No intervention
3 years uptake
Immediate uptake
6 years uptake
Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb
the growth of the HIV epidemic. J Infect Dis 2008; 198:59-67
HAART uptake
Coverage: from 50% to 75%
1 year
3 years
6 years
Averted New infections (N)
3,202
3,169
2,695
Total Cost Savings (CAN$)
49,310,494
48,801,574
41,506,163
Total Lifetime Cost Savings (CAN$) 1,163,727,652 1,151,717,136 979,545,445
HAART uptake
Coverage: from 50% to 90%
1 year
3 years
6 years
Averted New infections (N)
4,926
4,869
4,205
Total Cost Savings (CAN$)
75,868,259
74,989,186
64,766,118
Total Lifetime Cost Savings (CAN$) 1,790,490,908 1,769,744,789 1,528,480,393
HAART uptake
Coverage: from 50% to 100%
1 year
3 years
6 years
Averted New infections (N)
5,885
5,851
5,472
Total Cost Savings (CAN$)
90,636,910
90,108,679
84,266,694
Total Lifetime Cost Savings (CAN$) 2,139,031,087 2,126,564,814 1,988,693,986
ex at the age of 20 years: 23.6 years
Direct cost to treat each person with first-line therapy: $15,400 CAN
Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the
growth of the HIV epidemic. J Infect Dis 2008; 198:59-67
Return on increased investment resulting from status quo
approach versus 50% and 75% expansion scenarios
$850
$750
Guidelines before the year 2008
2008 Guidelines & 50% Expansion Scenario
2008 Guidelines & 75% Expansion Scenario
millions $
(cumulative)
$650
$550
$450
$350
$250
Lima V JID 2008
$150
$50
0
10
20
year
30
40
Current global ARV need
Number of people receiving antiretroviral drugs in low- and
middle-income countries (2002 - 2007)
UNAIDS & WHO 2008
Antiretroviral Therapy Coverage
(i.e. % of those who need therapy)
Geographical Region
Percent
Change
December 2006
(range)
December 2007
(range)
Sub-Saharan Africa
21% (18% - 23%)
30% (27% - 34%)
+ 43%
Latin America and the
Caribbean
58% (47% - 68%)
62% (51% - 70%)
+ 7%
East, South and South-East
Asia
18% (14% - 23%)
25% (20% - 32%)
+ 39%
Europe and Central Asia
13% (9% - 19%)
17% (12% - 22%)
+ 31%
5% (4% - 8%)
7% (5% - 10%)
+ 40%
22% (19% - 25%)
31% (27% - 34%)
+ 41%
North Africa and the Middle
East
Total
UNAIDS & WHO 2008
Funding gap between resource needs and resource availability
(2005-2007)
Needs
Availability
UNAIDS & WHO 2008
Effect of PEPFAR on HIV Incidence
Lima 2009
Where do we go next?
Scaling-up ART: Needs & Constraints
→ Cost (direct & indirect)
→ Limited Resources - How to prioritize the available funds?
→ Treatment Guidelines
- When to start?
- 1st & 2nd Line Therapy?
- Laboratory Monitoring
→ Treatment of Co-morbidities & other Health Issues
→ Long-term Sustainability: Health Systems & Funding
→ Other Concurrent Prevention Efforts
→ Social & Gender Inequalities
→ Cultural & Governmental Barriers
→ Human Rights Issues
…
Thanks!
Other slides
Effect of PEPFAR on HIV Incidence
Lima 2009
Current global ARV need
UNAIDS & WHO 2008