Rethink HIV: Treatment and Initiatives to Reduce the Impact of the HIV/AIDS Epidemic Perspective, Brent

Perspective Paper

This is one of the Perspectives Papers dealing with the Assessment Paper on Treatment by Mead Over and Geoffrey Garnett - hereafter O&G - as part of the RethinkHIV Project seeking how best to spend an extra $10 billion to combat HIV/AIDS in Sub-Saharan Africa. The purpose of the Perspectives Paper is to provide a counterbalance to the Assessment Paper by indicating areas of agreement, disagreement and discussion.

O&G find that treatment as prevention can produce benefit- cost (B/C) ratios in the range 3 to 3.5 in one scenario (“zero uptake”) and they are in the range 2.3 to 2.5 in the alternative scenario (“historical uptake’). In the sensitivity analysis, the B/C ratios never exceed 4. Our main contribution in this paper is to reconstruct their analysis using these ratios as benchmarks so that we can identify the types of assumption that can validate the O&G results. From there we add some new assumptions in the context of a particular type of treatment intervention not covered explicitly in the Assessment Paper.

Because the main contribution of the O&G paper is to formulate and estimate a transmission rate for HIV infection that depends on time, it constitutes an important first step towards constructing a dynamic evaluation of HIV Treatment. Given this, it seems useful to place their contribution within a more complete dynamic framework to help understand what the particular transmission mechanism specified contributes to the evaluation and to see also what is missing. The dynamic framework is presented in section 2.

A Perspective Paper on the topic of Treatment has been written by Robert J. Brent, Professor of Economics, Fordham University.