The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There?

The 2013 Lancet Commission Report, Global Health 2035, rightly pointed out that we are at a unique place in history where a “grand convergence” of health initiatives to reduce both infectious diseases, and child and maternal mortality – diseases that still plague low income countries – would yield g...

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Main Authors:	Wilson, David, Taaffe, Jessica, Fraser-Hurt, Nicole, Gorgens, Marelize
Format:	Journal Article
Language:	en_US
Published:	Taylor and Francis 2014
Subjects:	antiretroviral therapy cost-effectiveness health impact HIV/AIDS drug resistance health program enrollment adherence strategies
Online Access:	http://hdl.handle.net/10986/20478

id	okr-10986-20478
recordtype	oai_dc
spelling	okr-10986-204782021-04-23T14:03:56Z The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There? Wilson, David Taaffe, Jessica Fraser-Hurt, Nicole Gorgens, Marelize antiretroviral therapy cost-effectiveness health impact HIV/AIDS drug resistance health program enrollment adherence strategies The 2013 Lancet Commission Report, Global Health 2035, rightly pointed out that we are at a unique place in history where a “grand convergence” of health initiatives to reduce both infectious diseases, and child and maternal mortality – diseases that still plague low income countries – would yield good returns in terms of development and health outcomes. This would also be a good economic investment. Such investments would support achieving health goals of reducing under-five (U5) mortality to 16 per 1 000 live births, reducing deaths due to HIV/AIDS to 8 per 100 000 population, and reducing annual TB deaths to 4 per 100 000 population. Treatment as prevention (TasP) holds enormous potential in reducing HIV transmission, and morbidity and mortality associated with HIV/AIDS – and therefore contributing to Global Health 2035 goals. However, TasP requires large financial investments and poses significant implementation challenges. In this review, we discuss the potential effectiveness, financing and implementation of TasP. Overall, we conclude that TasP shows great promise as a cost-effective intervention to address the dual aims of reducing new HIV infections and reducing the global burden of HIV-related disease. Successful implementation will be no easy feat, though. The dramatic increases in the numbers of persons who need antiretroviral therapy (ART) under a TasP approach will pose enormous challenges at all stages of the HIV treatment cascade: HIV diagnosis, antiretroviral (ARV) initiation, ARV adherence and retention, and increased drug resistance with long-term enrollment on ART. Overcoming these implementation challenges will require targeted implementation, not focusing exclusively on TasP, most-at-risk population (MARP)-friendly services for key populations, integrating services, task shifting, more efficient program management, balancing supply and demand, integration into universal health coverage efforts, demand creation, improved ART retention and adherence strategies, the use of incentives to improve HIV treatment outcomes and reduce unit costs, continued operational research and tapping into technological innovations. 2014-10-28T18:49:58Z 2014-10-28T18:49:58Z 2014-07-21 Journal Article African Journal of AIDS Research 1608-5906 http://hdl.handle.net/10986/20478 en_US CC BY-NC-ND 3.0 IGO http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Taylor and Francis Publications & Research :: Journal Article
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	en_US
topic	antiretroviral therapy cost-effectiveness health impact HIV/AIDS drug resistance health program enrollment adherence strategies
spellingShingle	antiretroviral therapy cost-effectiveness health impact HIV/AIDS drug resistance health program enrollment adherence strategies Wilson, David Taaffe, Jessica Fraser-Hurt, Nicole Gorgens, Marelize The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There?
description	The 2013 Lancet Commission Report, Global Health 2035, rightly pointed out that we are at a unique place in history where a “grand convergence” of health initiatives to reduce both infectious diseases, and child and maternal mortality – diseases that still plague low income countries – would yield good returns in terms of development and health outcomes. This would also be a good economic investment. Such investments would support achieving health goals of reducing under-five (U5) mortality to 16 per 1 000 live births, reducing deaths due to HIV/AIDS to 8 per 100 000 population, and reducing annual TB deaths to 4 per 100 000 population. Treatment as prevention (TasP) holds enormous potential in reducing HIV transmission, and morbidity and mortality associated with HIV/AIDS – and therefore contributing to Global Health 2035 goals. However, TasP requires large financial investments and poses significant implementation challenges. In this review, we discuss the potential effectiveness, financing and implementation of TasP. Overall, we conclude that TasP shows great promise as a cost-effective intervention to address the dual aims of reducing new HIV infections and reducing the global burden of HIV-related disease. Successful implementation will be no easy feat, though. The dramatic increases in the numbers of persons who need antiretroviral therapy (ART) under a TasP approach will pose enormous challenges at all stages of the HIV treatment cascade: HIV diagnosis, antiretroviral (ARV) initiation, ARV adherence and retention, and increased drug resistance with long-term enrollment on ART. Overcoming these implementation challenges will require targeted implementation, not focusing exclusively on TasP, most-at-risk population (MARP)-friendly services for key populations, integrating services, task shifting, more efficient program management, balancing supply and demand, integration into universal health coverage efforts, demand creation, improved ART retention and adherence strategies, the use of incentives to improve HIV treatment outcomes and reduce unit costs, continued operational research and tapping into technological innovations.
format	Journal Article
author	Wilson, David Taaffe, Jessica Fraser-Hurt, Nicole Gorgens, Marelize
author_facet	Wilson, David Taaffe, Jessica Fraser-Hurt, Nicole Gorgens, Marelize
author_sort	Wilson, David
title	The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There?
title_short	The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There?
title_full	The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There?
title_fullStr	The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There?
title_full_unstemmed	The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There?
title_sort	economics, financing and implementation of hiv treatment as prevention : what will it take to get there?
publisher	Taylor and Francis
publishDate	2014
url	http://hdl.handle.net/10986/20478
_version_	1764445486182301696

The Economics, Financing and Implementation of HIV Treatment as Prevention : What Will it Take to Get There?

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