The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa.
Since November 2009, WHO recommends that adults infected with HIV should initiate antiretroviral therapy (ART) at CD4+ cell counts of ≤350 cells/µl rather than ≤200 cells/µl. South Africa decided to adopt this strategy for pregnant and TB co-infected patients only. We estimated the impact of fully a...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2011-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3140490?pdf=render |
| _version_ | 1818360952292114432 |
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| author | Jan A C Hontelez Sake J de Vlas Frank Tanser Roel Bakker Till Bärnighausen Marie-Louise Newell Rob Baltussen Mark N Lurie |
| author_facet | Jan A C Hontelez Sake J de Vlas Frank Tanser Roel Bakker Till Bärnighausen Marie-Louise Newell Rob Baltussen Mark N Lurie |
| author_sort | Jan A C Hontelez |
| collection | DOAJ |
| description | Since November 2009, WHO recommends that adults infected with HIV should initiate antiretroviral therapy (ART) at CD4+ cell counts of ≤350 cells/µl rather than ≤200 cells/µl. South Africa decided to adopt this strategy for pregnant and TB co-infected patients only. We estimated the impact of fully adopting the new WHO guidelines on HIV epidemic dynamics and associated costs.We used an established model of the transmission and control of HIV in specified sexual networks and healthcare settings. We quantified the model to represent Hlabisa subdistrict, KwaZulu-Natal, South Africa. We predicted the HIV epidemic dynamics, number on ART and program costs under the new guidelines relative to treating patients at ≤200 cells/µl for the next 30 years. During the first five years, the new WHO treatment guidelines require about 7% extra annual investments, whereas 28% more patients receive treatment. Furthermore, there will be a more profound impact on HIV incidence, leading to relatively less annual costs after seven years. The resulting cumulative net costs reach a break-even point after on average 16 years.Our study strengthens the WHO recommendation of starting ART at ≤350 cells/µl for all HIV-infected patients. Apart from the benefits associated with many life-years saved, a modest frontloading appears to lead to net savings within a limited time-horizon. This finding is robust to alternative assumptions and foreseeable changes in ART prices and effectiveness. Therefore, South Africa should aim at rapidly expanding its healthcare infrastructure to fully embrace the new WHO guidelines. |
| first_indexed | 2024-12-13T21:08:58Z |
| format | Article |
| id | doaj.art-55da5376e7004c7f95152e7532b4864b |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-13T21:08:58Z |
| publishDate | 2011-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-55da5376e7004c7f95152e7532b4864b2022-12-21T23:31:25ZengPublic Library of Science (PLoS)PLoS ONE1932-62032011-01-0167e2191910.1371/journal.pone.0021919The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa.Jan A C HontelezSake J de VlasFrank TanserRoel BakkerTill BärnighausenMarie-Louise NewellRob BaltussenMark N LurieSince November 2009, WHO recommends that adults infected with HIV should initiate antiretroviral therapy (ART) at CD4+ cell counts of ≤350 cells/µl rather than ≤200 cells/µl. South Africa decided to adopt this strategy for pregnant and TB co-infected patients only. We estimated the impact of fully adopting the new WHO guidelines on HIV epidemic dynamics and associated costs.We used an established model of the transmission and control of HIV in specified sexual networks and healthcare settings. We quantified the model to represent Hlabisa subdistrict, KwaZulu-Natal, South Africa. We predicted the HIV epidemic dynamics, number on ART and program costs under the new guidelines relative to treating patients at ≤200 cells/µl for the next 30 years. During the first five years, the new WHO treatment guidelines require about 7% extra annual investments, whereas 28% more patients receive treatment. Furthermore, there will be a more profound impact on HIV incidence, leading to relatively less annual costs after seven years. The resulting cumulative net costs reach a break-even point after on average 16 years.Our study strengthens the WHO recommendation of starting ART at ≤350 cells/µl for all HIV-infected patients. Apart from the benefits associated with many life-years saved, a modest frontloading appears to lead to net savings within a limited time-horizon. This finding is robust to alternative assumptions and foreseeable changes in ART prices and effectiveness. Therefore, South Africa should aim at rapidly expanding its healthcare infrastructure to fully embrace the new WHO guidelines.http://europepmc.org/articles/PMC3140490?pdf=render |
| spellingShingle | Jan A C Hontelez Sake J de Vlas Frank Tanser Roel Bakker Till Bärnighausen Marie-Louise Newell Rob Baltussen Mark N Lurie The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa. PLoS ONE |
| title | The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa. |
| title_full | The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa. |
| title_fullStr | The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa. |
| title_full_unstemmed | The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa. |
| title_short | The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa. |
| title_sort | impact of the new who antiretroviral treatment guidelines on hiv epidemic dynamics and cost in south africa |
| url | http://europepmc.org/articles/PMC3140490?pdf=render |
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