E-DRUG: antiretroviral drug use model in South Africa
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[Copied from lancet website under fair use. The full article is available
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Extent to which low-level use of antiretroviral treatment could curb the
AIDS epidemic in sub-Saharan Africa
Lancet 2000; 355: 2095 - 2100
Evan Wood, Paula Braitstein, Julio S G Montaner, Martin T Schechter,
Mark W Tyndall, Michael V O'Shaughnessy, Robert S Hogg
Correspondence to: Dr Robert Hogg, (e-mail: bobhogg@hivnet.ubc.ca)
Summary
Background
Despite growing international pressure to provide HIV-1 treatment to
less-developed countries, potential demographic and epidemiological
impacts have yet to be characterised. We modelled the future impact
of antiretroviral use in South Africa from 2000 to 2005.
Methods
We produced a population projection model that assumed zero
antiretroviral use to estimate the future demographic impacts of the
HIV-1 epidemic. We also constructed four antiretroviral-adjusted
scenarios to estimate the potential effect of antiretroviral use. We
modelled total drug cost, cost per life-year gained, and the proportion
of per-person health-care expenditure required to finance antiretroviral
treatment in each scenario.
Findings
With no antiretroviral use between 2000 and 2005, there will be
about 276 000 cumulative HIV-1-positive births, 2 302 000
cumulative new AIDS cases, and the life expectancy at birth will be
46�6 years by 2005. By contrast, 110 000 HIV-1-positive births
could be prevented by short-course antiretroviral prophylaxis, as well
as a decline of up to 1 year of life expectancy. The direct drug costs
of universal coverage for this intervention would be US$54
million--less than 0�001% of the per-person health-care expenditure.
In comparison, triple-combination treatment for 25% of the
HIV-1-positive population could prevent a 3�1-year decline in life
expectancy and more than 430 000 incident AIDS cases. The drug
costs of this intervention would, however, be more than $19 billion at
present prices, and would require 12�5% of the country's per-person
health-care expenditure.
Interpretation
Although there are barriers to widespread HIV-1 treatment, limited use
of antiretrovirals could have an immediate and substantial impact on
South Africa's AIDS epidemic.
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