A national prevention and treatment programme for HIV/Aids would save three million lives and cost no more than R18-billion a year by 2015, according to a cost-benefit analysis conducted by the University of Cape Town.
The researchers found that moves to reduce new HIV infections would save the state money, but that only treatment could turn the tide of Aids-related deaths in the short term. They presented the analysis in a report to Parliament last month.
The report, The Costs and Benefits of Preventing and Treating HIV/Aids, was compiled by the Centre for Actuarial Research (Care) at the University of Cape Town and was supported by financial analysis conducted by the university’s Centre for Social Science Research.
The Treatment Action Campaign (TAC) commissioned the research to calculate the costs of anti-retroviral treatment. The findings were presented to Parliament’s health portfolio committee a few weeks ago.
The research investigated the effect of different treatment and prevention strategies on the epidemic. It calculated that a national programme including anti-retroviral treatment would cost R224-million to implement, rise to R6,8-billion in 2007 and peak at R18,1-billion in 2015.
But these costs could be reduced to less than R10-billion in 2015 if an Aids vaccine were discovered, if the prices of anti-retroviral drugs were reduced, if the private sector paid for treating employees and if the United Nations’s Global Fund continued to provide funds.
Prevention and treatment could save about three million lives and more than 2,5-million people could be saved from HIV infection by 2015.
The researchers considered three scenarios. The first would only provide treatment for opportunistic infections; the second would add a programme, such as counselling and testing, and the management of sexually transmitted infections to prevent further infections; and the third would add an anti-retroviral treatment programme.
”If only opportunistic infections are treated … by 2015 a cumulative total of 15,5-million HIV infections will have occurred since 1985. Of these 15,5-million people, 9,3-million will have died. Life expectancy will drop to just above 40,” the researchers reported.
They calculated that the massive expense of dealing with Aids orphans would be radically decreased if anti-retroviral treatment were provided rather than only treatment for opportunistic infections.
The researchers found that by 2015 South Africa would have nearly three million maternal orphans younger than 18 if the state only provided treatment for opportunistic infections.
A treatment and prevention programme would limit the number of these orphans to about 700000. A programme of treating opportunistic infections combined with prevention would result in slightly more orphans than treatment alone. A full treatment and counselling programme would halve the number of orphans from two million to one million by 2015.
The parliamentarians heard that the social benefits of a treatment programme would far outweigh its costs.
”The financial cost of treatment must be measured against the direct and indirect financial savings that will be incurred [by implementing treatment and prevention] which are substantial,” said Nathan Geffen, spokesperson for the TAC.
He said that if the government pulled its weight the TAC would ensure that pressure was placed on the private sector to finance areas of the programme.
The TAC has already lodged a complaint with the Competition Commission against pharmaceutical companies that sell anti-retroviral drugs at hugely inflated prices in South Africa. Lower prices for drugs are central to any affordable Aids programme.
The researchers calculated that the price of generic anti-retroviral drugs would need to be reduced to about R400 a month for a treatment regimen that now costs about R1700. The TAC hopes to reduce the costs of anti-retrovirals to R275 a month.
”The social benefits to society are far larger than the sum of the benefits to individuals on highly active anti-retroviral treatment,” said Nicoli Nattrass, one of the researchers.
”The availability of life-prolonging treatment gives people the courage to come forward and be tested and counselled, thus increasing the general level of awareness of HIV and the need for safe sex. In addition, those on highly active anti-retroviral therapy have lower viral loads and are therefore less infectious.”
She said the Care actuaries Leigh Johnson and Rob Dorrington predicted that life expectancy would rise by eight to 10 years if a prevention and treatment programme were implemented. ”This is double the increase in life expectancy for a person on highly active antiretroviral therapy alone.”
Though the public health sector is obliged to treat opportunistic infections of people with HIV, the researchers found that it lacks the funding and the capacity to treat all these cases adequately. Hospitalisation costs would be significantly decreased by a prevention-and-treatment programme.
Glenda Gray, head of the maternal and child health care unit at Chris Hani Baragwanath hospital in Soweto, praised the common sense of the research.
”When you face a crisis like this you cannot look at prevention without looking at treatment. We need to fight the epidemic at every level.”
She says that treatment with anti-retroviral drugs would not only prolong and improve the lives of individuals with Aids, but would also benefit society and the economy. Gray says the proposed programme would decrease the number of orphans and would reduce pressure on the overstretched health establishment.
Last week Minister of Finance Trevor Manuel announced a R3,3-billion Budget allocation for HIV/Aids programmes. Nattrass said the money could cover the first phase of a programme that included anti-retroviral treatment. The researchers estimated that an anti-retroviral treatment programme would cost R2,1 billion for the first two years.
”The problem with the government’s Budget allocation is that it is an aggregate figure and there is no clarity as to how it is going to be spent. However, R3,3-billion is a good start,” said Nattrass.