Increases in antiretroviral treatment costs for HIV/AIDS patients in South Africa could be offset by the introduction of cost-saving measures, according to a new study led by a Boston University School of Public Health (BUSPH) researcher.
The study, published in PLOS–ONE, analyzed the cost of the current national South African HIV treatment program and estimated the expected cost and impact of treatment guidelines issued by the World Health Organization (WHO) between 2009 and 2016. Those guidelines aimed to steadily raise the threshold of eligibility for antiretroviral treatment (ART) while also providing better drugs for patients.
“The paper summarizes our close collaboration with the South African Department of Health and Treasury over the last eight years, which resulted in us helping to change public policy — an unusual situation for an academic,” says lead author Dr. Gesine Meyer-Rath, research assistant professor of global health at BUSPH. “While many factors have contributed to the remarkable expansion of HIV treatment in South Africa over the last decade, with the political will demonstrated by the current minister of health being the most important one, our model supported the process by allowing the department of health to submit budget bids to treasury that were based on precise estimates of patients in need of treatment and overall costs.”
The South African national ART program is the largest HIV/AIDS treatment program in the world, currently reaching almost four million patients. The program is one of the few in Africa that is funded by the government rather than international donors; the costs of the program have been increasing since its establishment.
The researchers worked with the South African government to analyze the costs and impacts of the program since 2009. They constructed the National ART Cost Model (NACM), a population-level budget impact model, to capture guideline changes by the WHO and to calculate how to offset the additional costs of the changing guidelines through implementing procurement, health systems, and technical improvements to the program.
The researchers found that certain cost-saving measures, such as introducing task-shifting and opening the drug tenders for international competition, would more than offset the increases in treatment costs under the 2009 WHO guidelines, and the introduction of adherence clubs for stable patients on ART would offset some of the costs of introducing universal treatment. The researchers predicted a reduction in the annual costs by 2024 as the program reaches universal coverage.