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Haïti Priorise: HIV, Stenberg

The Problem

Haiti has one of the highest rates of HIV/AIDS infection in the region, at 1.35% prevalence. HIV/AIDS was the top cause of death by rate in 2005, but in the ten years following was overtaken by ischemic heart disease and cerebrovascular disease, and is now the third most common cause of death. 

However it remains the top cause of premature death, and the top cause of death and disability combined. Over the past decade, efforts to curb the epidemic have resulted in significant advancements. The rate of new HIV infections fell by 54% and more than half of Haitians living with HIV are accessing antiretroviral therapy. However, the sustainability of these investments can be called into question as total expenditure on HIV/AIDS services is almost exclusively funded from external sources and the total amount spent exceeds the national health budget. 

The Solution

Expanding HIV testing and treatment: the analysis for treatment interventions considers the current global policy which is treatment as prevention, or TasP (no CD4 criterion for ART eligibility).

Preventive interventions

Treatment as prevention

Antiretroviral treatment (ART) as prevention, which effectively includes the following components:

  • Voluntary Counselling and Testing (VCT)
  • Adults first line ART
  • Adults second line ART
  • Pediatric ART for children
  • Preventing mother to child transmission (PMTCT) of HIV
  • Cotrimoxazole for children


Benefits, Costs, and BCR

Costs

Costs in USD millions:

Target level Commodities Service delivery Supply chain Program cost Total
80% Coverage Target, Absolute amount USD 5.4 0.6 0.9 0.5 7.4
80% Coverage Target, Absolute amount HTG 245.4 25.4 40.3 24.3 335.4
Percentage share of costs 73% 8% 12% 7% 100%
Coverage Target, Absolute amount USD 10.8 1.1 1.8 0.8 14.5
Coverage Target, Absolute amount HTG 490 49.8 80.3 37.6 657.7
Percentage share of costs 74% 8% 12% 6% 100%

Benefits

Number of average annual additional number of people reached with services:

  Additional number of people reached, average by year
Scenario VCT PMTCT ART Cotramoxazole for children
80% coverage target 7,899 78 15,174 259
95% coverage target 10,897 228 30,321 412

Projected health outcomes, total 2018-2036:

  Target coverage New infections AIDS deaths New infections averted AIDS deaths averted Gain in QALYs
Baseline Current coverage maintained 10,290 65,284 N/A N/A N/A
Treatment as preventions 80% 5,766 45,667 4,524 19,617 257,159
95% 3,735 30,016 6,555 35,268 441,165

Summary Table of the BCR

Intervention Target cover. Benefits (New Present Value) Costs (New Present Value) BCR
Treatment as prevention 80% 21,455,366,548 7,056,396,328 3.04
95% 36,676,541,077 11,740,016,921 3.12

Sector Expert Reviewer:

Project:

  • Haïti Priorise

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