A new HIV/AIDS initiative will require unprecedented investment, but will also increase survival, reduce the number of children orphaned by HIV, and contain the global AIDS epidemic, researchers estimate.
Launched in 2014, the overall goal of the Joint United Nations Programme on HIV/AIDS called 90-90-90 is to achieve viral suppression—reducing the viral load to an undetectable level—among 73 percent of HIV-infected persons worldwide by 2020. It is currently estimated that 24 percent of those with HIV have achieved viral suppression.
To meet the goal, the program has three key objectives: diagnosing 90 percent of HIV infections worldwide; linking 90 percent of identified cases to antiretroviral therapy (ART); and achieving virologic suppression among 90 percent of ART recipients.
For the study, published in the Annals of Internal Medicine, researchers used South African epidemiologic data and results from HIV screening and treatment programs to gauge the likely impact of 90-90-90 in South Africa and compared it with the currently projected pace of HIV detection and treatment over the next five and 10 years.
A computer simulation model showed that over the next decade, 90-90-90 would avert more than 2 million new HIV infections, more than 2.4 million deaths, and over 1.6 million orphans—saving an additional 13 million patient-years of life compared with the current pace of screening and treatment roll-out.
“We’re convinced, based on the results of our analysis, that successful implementation of the 90-90-90 targets would have a transformative impact on the AIDS epidemic worldwide,” says A. David Paltiel, professor at the Yale University School of Public Health.
Critics have expressed concern that the successful global implementation of 90-90-90 would require unprecedented cash infusions from donor organizations. “Our goal was to address that concern, providing donors and partner countries with pragmatic estimates of what 90-90-90 will cost and what returns they can expect on that investment,” says coauthor Linda-Gail Bekker of the Desmond Tutu HIV Centre and University of Cape Town.
The program’s cost would be $54 billion over the next 10 years, a 42 percent cost increase over current scale-up activities. But taken as a whole, the investment in 90-90-90 would yield a cost-effectiveness ratio of $1,260 per year of life saved, well within what is considered very cost effective for South Africa and a ratio similar to that of HIV treatment itself.
“Yes, it would be very expensive, but it would be worth every penny,” says lead author Rochelle P. Walensky, of the Massachusetts General Hospital’s Division of Infectious Disease.
The National Institutes of Health and the Steve and Deborah Gorlin Massachusetts General Hospital Research Scholars Award supported the study.
Source: Yale University