New UN targets for HIV / AIDS treatment costly, but could save millions of lives

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A new study estimates the impact of a Joint United Nations Program on HIV / AIDS initiative known as 90-90-90, and finds that while its goals for HIV testing and treatment will require a an unprecedented investment, it will increase survival, reduce the number of children orphaned by HIV and contain the global AIDS epidemic.

The study, co-authored by researchers at the Yale School of Public Health, Massachusetts General Hospital and the University of Cape Town, was published in the May 30 online edition of the Annals of Internal Medicine..

Launched in 2014, the overall goal of the 90-90-90 program is to achieve viral suppression – by reducing the viral load to an undetectable level – in 73% of people infected with HIV globally by 2020. It is currently estimated that 24% of people with HIV have achieved viral suppression. To achieve this goal, the program has three key goals: to diagnose 90% of people infected with HIV globally; link 90% of identified cases to antiretroviral therapy (ART); and achieving virologic suppression in 90% of ART recipients.

The researchers used South African epidemiological data and the results of HIV testing and treatment programs to assess the likely impact of 90-90-90 in South Africa and compared it to the currently expected rate of detection and HIV treatment over the next 5 and 10 years. Using a computer simulation model, the team found that over the next decade, 90-90-90 would prevent more than 2 million new HIV infections, more than 2.4 million deaths and over 1.6 million orphans, saving an additional 13 million patient-years. of life compared to the current pace of screening and treatment deployment.

“We are confident, based on the results of our analysis, that the successful implementation of the 90-90-90 goals would have a transformative impact on the AIDS epidemic around the world,” said A. David Paltiel, Professor at the Yale School of Public. Health and lead author of the study.

Critics have expressed concern that the successful global implementation of 90-90-90 would require unprecedented infusions of funding from donor organizations. “Our aim was to address this concern, by providing donors and partner countries with pragmatic estimates of what 90-90-90 will cost and the returns they can expect from this investment,” said Linda-Gail Bekker, MD, co-author of the study. the Desmond Tutu HIV Center and the University of Cape Town.

The cost of the program would be $ 54 billion over the next 10 years, a 42% increase over current scale-up activities. But overall, the study found that investing in 90-90-90 would yield a cost-effectiveness of $ 1,260 per year of life saved, well below what is considered highly profitable for the company. South Africa and a report similar to The HIV Treatment Itself, the authors said.

“Yes, that would be very expensive, but it would be worth every penny,” said Rochelle P. Walensky, MD, of the division of infectious diseases at Massachusetts General Hospital and lead author of the study.

Grants from the National Institutes of Health and the Steve and Deborah Gorlin Massachusetts General Hospital Research Scholars Award supported the study.

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