A fiscally responsible approach

Although significant costs are associated with increasing the number of people receiving ART for HIV infections, the test-and-treat strategy saves money over time by reducing the number of new infections that must be treated and by reducing the number of people who will need to be vaccinated once an effective vaccine has been developed.

In the November 26, 2008, edition of the British medical journal The Lancet, our colleague, Dr. Brian Williams, and four other distinguished researchers offered a mathematical look at the strategy of universal voluntary testing for HIV and immediate treatment with ART in South Africa. Other scientific work from South Africa, San Francisco, Vancouver and China supports this approach. National Institutes of Health’s recent HPTN 052 research study provides the scientific evidence to begin using test-and-treat on a larger scale.

The calculations for The Lancet article show that within five years of the start of voluntary annual testing nationwide, most infected South Africans could be put on ART. HIV incidence and mortality would then fall to less than one person in 1,000 within 10 years of full implementation of the strategy.

Overall it will cost less to implement the test-and-treat strategy, but initial startup will require more money upfront. However, we calculate that the initial cost of test-and-treat now would not be much greater than the cost of conventional testing and treatment because the costs of treating many more people would be largely offset by the money that would otherwise be spent on treating people who become ill with AIDS-related diseases. A recent economic study by Harvard published in the October 2011 issue of PLoS ONE reaches a similar conclusion.

2016 estimates from the South African Centre for Epidemiological Modelling and Analysis suggest that if an additional $22 billion above current levels is spent over five years ($4.4 billion per year) to implement test-and-treat in 21 African countries where the virus is widespread, HIV transmissions can be stopped and the epidemic can be halted. As part of its advocacy efforts, TTEA and other partners are exploring a range of funding options, including quantitative easing, to fully fund $22 billion for this humanitarian campaign.