New U.N. targets for HIV/AIDS treatment expensive, but could save millions of lives

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A new study estimates the impact of an initiative of the Joint United Nations Programme on HIV/AIDS known as 90-90-90, and finds that while its targets for HIV testing and treatment will require unprecedented investment, it will increase survival, reduce the number of children orphaned by HIV, and contain the global AIDS epidemic.

The study, co-authored by researchers at the Yale School of Public Health, Massachusetts General Hospital, and the University of Cape Town, was published in the May 30 online edition of the Annals of Internal Medicine.

Launched in 2014, the 90-90-90 program’s overall goal is to achieve viral suppression — reducing the viral load to an undetectable level — among 73% of HIV-infected persons worldwide by 2020. It is currently estimated that 24% of those with HIV have achieved viral suppression. To meet the goal, the program has three key objectives: diagnosing 90% of HIV-infected persons worldwide; linking 90% of identified cases to antiretroviral therapy (ART); and achieving virologic suppression among 90% of ART recipients.

The 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 5 and 10 years. Using a computer simulation model, the team found 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,” said A. David Paltiel, professor at the Yale School of Public Health and senior author of the study.

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,” said study co-author Linda-Gail Bekker, M.D., 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% cost increase over current scale-up activities. But taken as a whole, the study found that 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, the authors said.

“Yes, it would be very expensive, but it would be worth every penny,” said Rochelle P. Walensky, M.D., of the Massachusetts General Hospital’s Division of Infectious Disease and the study’s lead author.

Grants from the National Institutes of Health and the Steve and Deborah Gorlin Massachusetts General Hospital Research Scholars Award supported the study.

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