RethinkHIV: Smarter Ways to Invest in Ending HIV in Sub-Saharan Africa
Thirty years after the identification of the disease that became known as AIDS, humanitarian organizations warn that the fight against HIV/AIDS has slowed, amid a funding shortfall and donor fatigue. In this book, Bjørn Lomborg brings together research by world-class specialist authors, a foreword by UNAIDS founding director Peter Piot and perspectives from Nobel Laureates and African civil society leaders to identify the most effective ways to tackle the pandemic across sub-Saharan Africa. There remains an alarming lack of high-quality data evaluating responses to HIV. We still know too little about what works, where and how to replicate our successes. This book offers the first comprehensive attempt by teams of authors to analyze HIV/AIDS policy choices using cost-benefit analysis, across six major topics. This approach provides a provocative fresh look at the best ways to scale up the fight against this killer epidemic.
2012 costs 22 24 $733.5 $5,000 6.25 6.05 5.90 2050 costs 22 24 $1,004.6 $5,000 4.56 4.41 4.31 2012 costs 22 24 $2,117.1 $5,000 2.16 2.09 2.04 2050 costs 22 24 $2,939.7 $5,000 1.56 1.51 1.47 2nd-line treatment Initiation of treatment: CD4 < 50 1st-line treatment 2012 costs 14 15 $733.5 $5,000 6.36 6.26 6.19 2050 costs 14 15 $1,004.6 $5,000 4.65 4.57 4.52 2012 costs 14 15 $2,117.1 $5,000 2.20 2.17 2.15 2050 costs 14 15 $2,939.7 $5,000
with treatment scale-up. The cross-section analysis is not relevant and treatment side-effects are not recognized, as we now explain. First, health care facilities in SSA are mainly in the urban areas, where population densities are high. Rural areas are underserved. To expand treatment in SSA will involve going into the rural areas, where transport costs will inhibit uptake. These transport costs, including the opportunity cost of time, need to be factored into the average cost estimates. Assume
The assessment paper identifies three possible solutions for lessening sexual transmission of HIV: male circumcision; HIV counseling and testing; and information campaigns. This is essentially one biomedical intervention and two social interventions. Before commenting on these solutions it is worth noting that in all cases the assessment paper discusses this as a decrease in infection among young men. This is of concern, as the bulk of infections are in young women. The paper assumes that male
incremental cost to finish scaling up pMTCT programs is $196 million, with over 1.2 million HIV-positive pregnant women receiving ARV prophylaxis between 2011 and 2015, while the cumulative incremental cost to institute interventions targeting IDU is $8.5 million, serving 20,000 IDU over five years. The grand total required for all four sets of interventions to reduce non-sexual transmission of HIV is $391 million. Some caveats should be attached to these results, some of which will be addressed
CD4 count or disease stage (National Institutes of Health: IMPAACT Trial Network 2010; Schouten, Jahn et al. 2011). Of these therapeutic options, Option A has the lowest medication costs. Moreover, the effectiveness of these strategies in preventing MTCT in the perinatal period and during breastfeeding is considered equivalent (World Health Organization 2010; UNAIDS Reference Group on Estimates Modelling and Projections 2011). The AP therefore chooses to evaluate the costs and benefits of a