Featured Research

from universities, journals, and other organizations

Proposal by WHO to eliminate AIDS in South Africa is flawed, model shows

Date:
September 18, 2010
Source:
University of California -- Los Angeles
Summary:
The World Health Organization has proposed a new strategy for combating the AIDS epidemic in South Africa. It is a strategy that is seriously flawed, say researchers.

In 2008, Reuben Granich and his colleagues at the World Health Organization published a paper in the medical journal The Lancet that proposed a new strategy for combating HIV in South Africa, a country staggered by the virus, with as much as 18 percent of the population estimated to be infected.

Based on a mathematical model, the study suggested a "test-and-treat" strategy. This would involve, among other steps, testing the entire population of South Africa for HIV and immediately beginning anti-retroviral therapy for all who tested positive. The current standard of care calls for waiting until symptoms appear after diagnosis.

Such a test-and treat strategy, the authors suggested, could eventually lead to the elimination of HIV in South Africa within a decade. Since then, the utility and feasibility of this approach have been widely debated, and it remains the leading potential prevention strategy for South Africa.

One aspect of the proposal that has not been examined, however, is the strategy's full estimated cost. Now, UCLA researchers have done their own modeling study and found that the costs have been substantially underestimated.

Reporting in the current online edition of The Lancet, Sally Blower, director of UCLA's Center for Biomedical Modeling and a member of the UCLA AIDS Institute, and Bradley Wagner, a postdoctoral scholar in Blower's lab, used their own sophisticated modeling techniques to duplicate the estimated cost curve used in the WHO report. They found that key potential costs -- including the expense of annual testing for a population of 32 million, the implementation of prevention programs and the "ramping up" of a health infrastructure that is currently overwhelmed -- were not included in the proposed approach.

Because the WHO did not disclose what costs they included in their estimates, Blower said, the UCLA researchers reconstructed it on their own. Using their own mathematical modeling, the researchers devised a cost curve based only on treatment costs.

The WHO report assumed that the maximum cost of treating a patient with first-line drugs would be $1,163 a year, and treatment with second-line drugs -- initiated when first-line therapy is no longer effective -- would be $4,083 a year. The WHO authors also assumed that 97 percent of patients would need first-line drugs and 3 percent would need second-line drugs each year.

Using this information, and the estimated 4.5 million individuals who would, once identified, need treatment annually, the UCLA researchers constructed a maximum cost curve that, for the first five years after implementation, exactly matched the cost estimated by the WHO.

And that is the problem, Blower said.

"Their cost curves are only based on treatment costs," she said. "They do not include the costs of an annual testing program for the 27 million adults in South Africa who are currently uninfected, nor do they include the costs of the extensive prevention interventions that are necessary to reduce transmission."

Most importantly, they also do not include any costs for the tenfold scaling up in the health care infrastructure that would be necessary to reach the entire population, Blower said.

"The health infrastructure in South Africa is at capacity now," Wagner said. "As a result, just reaching the entire population, many of whom live in remote rural areas in a country almost twice the size of Texas, would be hugely expensive and should be taken into account."

"Certainly, we should treat people who need it," Blower said. "But the costs of a universal test-and-treat strategy in South Africa have been substantially underestimated."


Story Source:

The above story is based on materials provided by University of California -- Los Angeles. The original article was written by Mark Wheeler. Note: Materials may be edited for content and length.


Journal References:

  1. Bradley Wagner, Sally Blower. Costs of eliminating HIV in South Africa have been underestimated. The Lancet, 2010; 376 (9745): 953-954 DOI: 10.1016/S0140-6736(10)61442-0
  2. Reuben M Granich, Charles F Gilks, Christopher Dye, Kevin M De Cock, Brian G Williams. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. The Lancet, 2009; 373 (9657): 48 DOI: 10.1016/S0140-6736(08)61697-9

Cite This Page:

University of California -- Los Angeles. "Proposal by WHO to eliminate AIDS in South Africa is flawed, model shows." ScienceDaily. ScienceDaily, 18 September 2010. <www.sciencedaily.com/releases/2010/09/100917090842.htm>.
University of California -- Los Angeles. (2010, September 18). Proposal by WHO to eliminate AIDS in South Africa is flawed, model shows. ScienceDaily. Retrieved April 24, 2014 from www.sciencedaily.com/releases/2010/09/100917090842.htm
University of California -- Los Angeles. "Proposal by WHO to eliminate AIDS in South Africa is flawed, model shows." ScienceDaily. www.sciencedaily.com/releases/2010/09/100917090842.htm (accessed April 24, 2014).

Share This



More Health & Medicine News

Thursday, April 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Big Pharma Braces for M&A Wave

Big Pharma Braces for M&A Wave

Reuters - Business Video Online (Apr. 22, 2014) Big pharma on the move as Novartis boss, Joe Jimenez, tells Reuters about plans to transform his company via an asset exchange with GSK, and Astra Zeneca shares surge on speculation that Pfizer is looking for a takeover. Joanna Partridge reports. Video provided by Reuters
Powered by NewsLook.com
Study Says Most Crime Not Linked To Mental Illness

Study Says Most Crime Not Linked To Mental Illness

Newsy (Apr. 22, 2014) A new study finds most crimes committed by people with mental illness are not caused by symptoms of their illness or disorder. Video provided by Newsy
Powered by NewsLook.com
Hagel Gets Preview of New High-Tech Projects

Hagel Gets Preview of New High-Tech Projects

AP (Apr. 22, 2014) Defense Secretary Chuck Hagel is given hands-on demonstrations Tuesday of some of the newest research from DARPA _ the military's Defense Advanced Research Projects Agency program. (April 22) Video provided by AP
Powered by NewsLook.com
How Smaller Plates And Cutlery Could Make You Feel Fuller

How Smaller Plates And Cutlery Could Make You Feel Fuller

Newsy (Apr. 22, 2014) NBC's "Today" conducted an experiment to see if changing the size of plates and utensils affects the amount individuals eat. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins