XIX International AIDS Conference


MOAE02 Investing in Treatment: Now and Later
  Oral Abstract Session : Track E
Venue: Session Room 8
Time: 23.07.2012, 14:30 - 16:00
Co-Chairs: Howard Friedman, United States
Charlotte Watts, United Kingdom
 
 

14:30
MOAE0201
Abstract
Powerpoint
Webcast
Cost and efficiency analysis of the Avahan HIV prevention programme for high risk groups in India
S. Chandrashekar1, A. Vassal2, G. Shetty3, M. Alary4, P. Vickerman2
1St. John's Research Institute, Dept of Epidemiology, Bangalore, India, 2London School of Hygiene and Tropical Medicine, Global Health and Development, London, United Kingdom, 3Karnataka Helath Promotion Trust, Bangalore, India, 4Centre Hospitalier affilie Universitaire de Quebec, Population Health Research, Quebec, Canada
S. Chandrashekar, India

14:45
MOAE0202
Abstract
Powerpoint
Webcast
Is treatment as prevention the new game-changer? Costs and effectiveness
T. Bärnighausen1,2, D. Bloom1, S. Humair1,3
1Harvard School of Public Health, Boston, United States, 2bAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubetuba, South Africa, 3School of Science and Engineering, Lahore University of Management Sciences, Lahore, Pakistan
T. Barnighausen, United States

15:00
MOAE0203
Abstract
Company-level ART provision to employees is cost saving: a modelled cost-benefit analysis of the impact of HIV and antiretroviral treatment in a mining workforce in South Africa
G. Meyer-Rath1,2,3, J. Pienaar4, B. Brink5, A. van Zyl6, D. Muirhead6, A. Grant7, G. Churchyard6, C. Watts2, P. Vickerman8
1Boston University Center for Global Health and Development, Boston, United States, 2London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, United Kingdom, 3University of the Witwatersrand, Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa, 4Highveld Hospital, Thermal Coal, Emhalahleni, South Africa, 5Anglo American, Johannesburg, South Africa, 6The Aurum Institute, Johannesburg, South Africa, 7London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom, 8London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom
P. Vickerman, United Kingdom

15:15
MOAE0204
Abstract
Powerpoint
Webcast
Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States
T.Q. Nguyen1, B.W. Weir1, S.D. Pinkerton2, D.C. Des Jarlais3, D. Holtgrave1
1Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, United States, 2Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Milwaukee, United States, 3Beth Israel Medical Center and North American Syringe Exchange Network, New York, United States
T. Nguyen, United States

15:30
MOAE0205
Abstract
Powerpoint
Webcast
Transition from stavudine to tenofovir and zidovudine for first-line treatment of HIV/AIDS in low- and middle-income countries
E. Dancel, P. Ashigbie
Boston University School of Medicine, Department of Family Medicine, Boston, United States
P. Ashigbie, United States

Powerpoints presentations
Cost and efficiency analysis of the Avahan HIV prevention programme for high risk groups in India - Sudha Chandrashekar

Is treatment as prevention the new game-changer? Costs and effectiveness - Till Barnighausen

Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States - Trang Q. Nguyen
Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States - Trang Q. Nguyen

Transition from stavudine to tenofovir and zidovudine for first-line treatment of HIV/AIDS in low- and middle-income countries - Paul Ashigbie



Rapporteur report

Track E report by Freddy Perez


MOAEO2

Investing in Treatment and Prevention now more than ever

There are few robust studies on the cost-effectiveness of HIV prevention at scale conducted in Asia. This session initiated with a presentation of the results of the efficiency of HIV prevention interventions for high-risk groups in districts of Southern India in the context of a large-scale programme effort. This is one of the largest HIV prevention programmes targeted at high-risk groups in the world operating across six Indian states between 2004 and 2009 (funding US $258 million). Specific considerations in costing included the provider perspective, top down expenditure costing, full costing, timeframe (start-up versus implementation), multi-year costing and discount rate (3%). Output included number of persons reached by the project and total contacts. Results showed that the main driver of costs was scale with all districts included in addition to age of the intervention, coverage levels / time of programme, specific settings and environmental drivers of costs.  Main policy implications highlighted have been: efficiency improves as the programme scales up; but total costs do not necessarily fall; above service level costs can be high to scale up prevention rapidly and costs have risen over time due to inclusion of structural interventions.

South Africa has the largest number of HIV-infected individuals worldwide with a large public sector programme (>1.7 million on ART), 85% publicly funded. Many companies in South Africa have HIV care and treatment programmes. There have not been economic evaluations of a workplace ART programme. A cost benefit analysis of coal mining company’s ART programme compared to if it did not provide ART was presented. For this, an employer’s perspective was used, considering incremental costs of HIV-infected employees with and without ART. Here, a 20-year time period from start of programme in 2003 was considered. Conclusions show that scaling up ART provision to workforce can reduce the total cost of HIV-positive employees, while increasing their survival: 1) savings are in large parts due to a reduction in benefit and absenteeism costs and 2) workplace-based provision of ART could be an economically viable alternative to scaling up public-sector programmes.

There is a need to increase investment in syringe exchange in the U.S. Key results of a model looking at the incidence of HIV due to injection risk showed that if increase Syringe Exchange Programme (SEP) coverage from current 2.9% of injections to 5% – 10% will avert about 170 – 500 HIV infections per year, require 19 – 64 million USD additional funding (for typical SEP services) or 9.4 – 32 million USD (for minimal exchange service); save 66 – 193 million USD in HIV treatment cost and would have a rate of return on investment of 3.5 – 3 (or 7 – 6). Main recommendation highlighted were: syringe exchange should be made a priority in HIV prevention in the US, the ban on use of federal funding for syringe exchange should be lifted, and federal funding should be allocated to syringe exchange

Considering that d4T has been a backbone of the 1st line of regimens (60% of patients on d4T in lower and middle-income [LMINC] countries), there was a need to withdraw d4T in adult regimens (WHO, 2009) and replace with TDF and ZDV-based regimens. A study described how the volume of d4T, TDF, and ZDV product purchases have changed in LMICs since the 2009 WHO recommendations and examined how the prices of these commodities have changed over the same period. Main conclusions reported were that the transition from d4T to ZDV and TDF has been slow, transition seems to be at a relatively higher rate in middle-income countries, no preference for 3-in-1 TDF based regimens and prices of 3-in-1 fixed-dose combinations of TDF stagnated despite increased volume of purchases.

 




   

    The organizers reserve the right to amend the programme.


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