More that 1.2 million deaths could be prevented in South Africa over the next five years by accelerating efforts to provide access to antiretroviral therapy (ART), according to a study released online today by the Journal of Infectious Diseases. Using a sophisticated mathematical model of HIV disease and treatment, a team of researchers led by Rochelle Walensky, MD, MPH of Massachusetts General Hospital (MGH) estimated the number of AIDS-related deaths in South Africa through 2012 under alternative ART scale-up assumptions.
The study results underscore the urgent need for Congress to reauthorize the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), which has supported the South African government's effort to increase access to antiretroviral therapy, the researchers note. "If ART is not provided to all who need it, HIV mortality will be enormous," says Walensky. "Deliberate, purposeful, and expedient scale-up will save millions of lives in South Africa alone."
South Africa has one of the largest burdens of HIV infection in the world, with 5 to 6 million individuals and 19 percent of adults aged 15 to 49 infected. While government programs supported by PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria have steadily increased access to antiretrovirals, at the end of 2006 only a third of individuals eligible for the therapy were receiving it.
In order to quantify the potential impact of various strategies for increasing access to ART, the research team projected the number of deaths under five scenarios -- ranging from maintaining current access levels, through steady and moderate growth levels, to rapid growth and full access for all patients requiring treatment. Among other factors, calculations were based on the fact that the one-year survival rate for eligible patients who receive antiretroviral therapy is 94 percent, while only 55 percent of those not treated would be expected to survive one year.
Results showed that maintaining current treatment capacity would lead to 2.4 million AIDS-related deaths by 2012. Rapid scale-up, whereby everyone in need would have access by 2011, would reduce the projected number of deaths to 1.2 million during that time period, and immediate full access for all eligible patients would drop deaths to 800,000.
The researchers note that efforts to scale up treatment have resulted in a fivefold increase in access to ART in low and moderate-income countries. "Continued investments in antiretroviral treatment programs worldwide are a public health imperative; the potential loss of life without such support is simply unacceptable," says Walensky, who is an associate professor of Medicine at Harvard Medical School.
The study was funded by the National Institute of Allergy and Infectious Diseases and the Doris Duke Charitable Foundation. Study co-authors are Mariam Fofana, Nomita Divi, Bingxia Wang, and Kenneth Freedberg of the MGH; Robin Wood, University of Cape Town, South Africa; Milton Weinstein and Sue Goldie, Harvard School of Public Health; Neil Martinson, Johns Hopkins University; Elena Losina, Brigham and Women's Hospital; Yazdan Yazdanpanah, Laboratory of Economic and Social Research, Lille, France; and A. David Paltiel, Yale University School of Medicine.
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