Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS [email protected]
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Transcript of Viviane Dias Lima British Columbia Centre for Excellence in HIV/AIDS [email protected]
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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/[email protected]
British Columbia Centre for Excellence in HIV/AIDS
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Rationale Evidence
HAART stops HIV replication
HIV levels fall to undetectable
in blood as well as in sexual
fluids
Sharp reduction in HIV
transmission
MTCT (De Cock 2000; Coovadia 2009)
PEP (Pinkerton 2004, Fisher 2006)
Discordant Couples (Quinn
2000; Castilla 2005; Wawer 2005;
Bechange 2008; Garnett 2008)
Population-based studies (Fang 2004; Lima 2007; Anema 2009)
Mathematical Models (Blower
2000; Law 2001; Abbas 2006; Montaner
2006; Lima 2007-2009; Granich 2009; De
Cock 2009)
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Evidence from British Columbia
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Lima V JID 2008
Increase HAART Coverage from 50% to 75%
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1995 2005 2015 2025 2035
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Increase HAART Coverage from 50% to 75%
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ost
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No intervention Immediate uptake 3 years 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
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ex at the age of 20 years: 23.6 yearsDirect cost to treat each person with first-line therapy: $15,400 CAN
Lima VD, et al. Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 2008; 198:59-67
1 year 3 years 6 yearsAverted New infections (N) 3,202 3,169 2,695Total Cost Savings (CAN$) 49,310,494 48,801,574 41,506,163
Total Lifetime Cost Savings (CAN$) 1,163,727,652 1,151,717,136 979,545,445
Coverage: from 50% to 75%HAART uptake
1 year 3 years 6 yearsAverted New infections (N) 4,926 4,869 4,205Total Cost Savings (CAN$) 75,868,259 74,989,186 64,766,118
Total Lifetime Cost Savings (CAN$) 1,790,490,908 1,769,744,789 1,528,480,393
Coverage: from 50% to 90%HAART uptake
1 year 3 years 6 yearsAverted New infections (N) 5,885 5,851 5,472Total Cost Savings (CAN$) 90,636,910 90,108,679 84,266,694
Total Lifetime Cost Savings (CAN$) 2,139,031,087 2,126,564,814 1,988,693,986
Coverage: from 50% to 100%HAART uptake
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Lima V JID 2008
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0 10 20 30 40year
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$(c
umul
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Guidelines before the year 20082008 Guidelines & 50% Expansion Scenario2008 Guidelines & 75% Expansion Scenario
Return on increased investment resulting from status quo approach versus 50% and 75% expansion scenarios
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Current global ARV need
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Number of people receiving antiretroviral drugs in low- and middle-income countries (2002 - 2007)
UNAIDS & WHO 2008
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Geographical Region
Antiretroviral Therapy Coverage(i.e. % of those who need therapy)
Percent ChangeDecember 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%
North Africa and the Middle East
5% (4% - 8%) 7% (5% - 10%) + 40%
Total 22% (19% - 25%) 31% (27% - 34%) + 41%UNAIDS & WHO 2008
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Funding gap between resource needs and resource availability (2005-2007)
Needs
Availability
UNAIDS & WHO 2008
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Effect of PEPFAR on HIV Incidence
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Lima 2009
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Where do we go next?
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…
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
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Thanks!
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Other slides
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Effect of PEPFAR on HIV Incidence
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Lima 2009
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Current global ARV need
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UNAIDS & WHO 2008