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Transcript of Washington D.C., USA, 22-27 July 2012 Estimating the Costs and Impacts of HIV/AIDS Programs for...
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Estimating the Costs and Impacts of HIV/AIDS Programs for Botswana
Examples of the ART Program and Various Prevention Strategies
Presented by: Peter M. Stegman,Sr. Economist & Managing Director,
Futures Institute Southern Africa Office
ACHAP Symposium - International AIDS ConferenceWashington DC, USA
23rd July 2012
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Botswana Background
• Despite its successes, Botswana still suffers one of the worst epidemics globally
• The national ART program has greatly curbed HIV-related mortality by achieving 90% coverage
• Prevention efforts, however, have not kept pace – accounting for less than 10% of total AIDS expenditure1
1National AIDS Coordinating Agency (2011), National Operational Plan for HIV and AIDS, GOB.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Some Limitations of study
• Study done in advance of release of important up-to-date data
• Completeness and currency of program data was sometimes a challenge
• Lack of data on CD4 progression rates and ART mortality by CD4 count at initiation
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Spending for HIV and AIDS2
• Since the ‘90s the GoB has increased health spending
• By 2008 GoB was spending BWP 1.5bn ($ 220m) on HIV/AIDS annually
• Over the same period, donor funding also increased
• Currently GoB funds about 70% of national HIV/AIDS program
• Faced with scaled back donor funding, the global economic crisis and constrained domestic revenues, GoB is concerned about HIV/AIDS program sustainability
2National AIDS Coordinating Agency (2010), Botswana National AIDS Spending Assessment 2006-2008, GOB.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
The ART Program in Perspective
• Program started in 2002 in four primary sites• By 2004 there was at least one treatment site
in each of the 27 health districts• Presently there are 32 ART sites and 212
satellite dispensing clinics across the country• At end of March 2012 there were just over
184,000 people on treatment• In 2010, the WHO recommended easing ART
initiation guidelines to levels <CD4 350
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Modeling ART Guideline Change
• Created baseline projection in which ART initiation threshold was CD4 250
• Developed alternative scenario in which ART initiation threshold was relaxed to CD4 350
• In both scenarios coverage was held at 90%• The difference between the baseline and the
CD4 350 scenario produced counterfactual impacts and costs for the ART program to 2016
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Estimated New & Existing ART Patients
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Additional Eligible ART Patients Due to Guideline Change to CD4 350
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Increased Care & Treatment Costs 20123
3Amounts for OI are marginal in either case and are therefore not visible here
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Prevention Scenarios
• Baseline• CD4 350• High Impact Prevention• Universal Access
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Number of New Infections by Scenario
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Costs by Intervention & Scenario
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Incremental Costs of Prevention ScenariosIndicator Baseline CD4 350 High Impact
PreventionUniversal Access
New Infections (2012-2016)
63,700 51,000 38,200 32,400
Infections Averted 12,700 25,600 31,300Total Cost in Millions of US$ (2012-2016)
$2,170 $2,430 $2,530 $2,750
Additional Cost in Millions of US$
$255 $360 $575
Cost-effectiveness per infection averted (excludes deaths averted)
$20,200 $14,000 $18,300
Incremental Cost-Effectiveness Ratio
$20,200 $7,900 $37,300
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Incremental Costs of Prevention ScenariosIndicator Baseline High Impact
Prevention CD4 250
High Impact Prevention CD4 350
New Infections (2012-2016) 63,700 47,600 38,200
Infections Averted 16,200 25,600Total Cost in Millions of US$ (2012-2016)
$2,170 $2,270 $2,530
Additional Cost in Millions of US$ $100 $360
Cost-effectiveness per infection averted (excludes deaths averted)
$6,500 $14,000
Incremental Cost-Effectiveness Ratio $6,500 $7,900
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Total Costs by Scenario 2012-2016
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusions
• Future benefits of raising ART initiation threshold to <CD4 350 for general population include infections averted and reduced HIV-related mortality
• Depending on the rate of increase in new ART patients, the MOH may be able to cope through “spike” period
• High impact prevention strategy is cost effective and averts infections, but without expansion of ART, the cost in avoidable HIV-related deaths may be much too high
Washington D.C., USA, 22-27 July 2012www.aids2012.org
This report was a collaborative effort between:
The conclusions and recommendations of this report are to provide the MOH and the
Government of Botswana with the evidence to make appropriate, informed decisions about the
pace and scope of treatment and prevention program scale-up
.
Ntwa e Bolotse
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Thank You