Estimating the resources required in the roll-out of universal access to antiretroviral treatment in Zimbabwe

Abstract

ObjectivesTo develop projections of the resources required (person-years of drug supply and healthcare worker time) for universal access to antiretroviral treatment (ART) in Zimbabwe.MethodsA stochastic mathematical model of disease progression, diagnosis, clinical monitoring and survival in HIV infected individuals.FindingsThe number of patients receiving ART is determined by many factors, including the strategy of the ART programme (method of initiation, frequency of patient monitoring, ability to include patients diagnosed before ART became available), other healthcare services (referral rates from antenatal clinics, uptake of HIV testing), demographic and epidemiological conditions (past and future trends in incidence rates and population growth) as well as the medical impact of ART (average survival and the relationship with CD4 count when initiated). The variations in these factors lead to substantial differences in long-term projections; with universal access by 2010 and no further prevention interventions, between 370 000 and almost 2 million patients could be receiving treatment in 2030—a fivefold difference. Under universal access, by 2010 each doctor will initiate ART for up to two patients every day and the case-load for nurses will at least triple as more patients enter care and start treatment.ConclusionsThe resources required by ART programmes are great and depend on the healthcare systems and the demographic/epidemiological context. This leads to considerable uncertainty in long-term projections and large variation in the resources required in different countries and over time. Understanding how current practices relate to future resource requirements can help optimise ART programmes and inform long-term public health planning.

Should Home-Based HIV Testing and Counseling Services be Offered Periodically in Programs of ARV Treatment as Prevention? A Case Study in Likoma (Malawi)

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Combination Prevention: New Hope for Stopping the Epidemic

“…Condom use will continue to be emphasized as an adjunctive tool for HIV/STI risk reduction [292, 299, 300]. The biomathematics of combining methods for prevention are compelling, but intimidating at the same time; substantial coverage will be needed to succeed in bringing the basic reproductive rate to <1 thereby offering the potential prospect of eventual elimination of HIV as a public health problem [34, 301–309, 310•, 311–313]. …”

Life Expectancies of South African Adults Starting Antiretroviral Treatment: Collaborative Analysis of Cohort Studies

“…Estimates of life expectancies of HIV-infected individuals are important in providing information to patients about their long-term prognosis, in projecting the future costs of HIV-related care, and in forecasting the likely future demographic and socioeconomic impact of HIV/AIDS [1]–[3]. Several estimates of the life expectancy of HIV-positive adults in high-income countries have been published [4]–[13], and many of these studies have shown dramatic improvements in life expectancy following the introduction of highly active antiretroviral treatment (ART).…”