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 |