Lives Saved by Expanding HIV Treatment Availability in Resource-Limited Settings: The Example of Haiti

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 63; no. 2; pp. e40 - e48
• Main Authors: Kimmel, April D, Charles, Macarthur, Deschamps, Marie-Marcelle, Severe, Patrice, Edwards, Alison M, Johnson, Warren D, Fitzgerald, Daniel W, Pape, Jean W, Schackman, Bruce R
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-06-2013; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - economics; Acquired Immunodeficiency Syndrome - mortality; AIDS/HIV; Anti-HIV Agents - economics; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - economics; CD4 Lymphocyte Count; Developing Countries - economics; Disease Progression; Drug therapy; Expansion; Forecasting; Haiti; Health Resources - economics; Health Resources - trends; Healthcare Financing; HIV; Human immunodeficiency virus; Humans; Indexing in process; Markov Chains; Mortality; Treatment Outcome; Haiti
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0b013e3182918875

BACKGROUND:Guidelines recommend antiretroviral therapy (ART) initiation at CD4 <350 cells per microliter for HIV-infected individuals in resource-limited settings. However, funding for treatment expansion remains uncertain. We forecast the mortality impact of ART expansion alternatives in Haiti.
METHODS:We used data from Haiti to develop a country-specific model of HIV disease. The model projects the mortality, total number of HIV-infected individuals, and number and coverage (percentage of those eligible) on ART by simulating cohorts of HIV-infected individuals over 10 years. Five ART expansion scenarios, ranging from fully expanded ART (best case) to No New ART (worst case), were assessed.
RESULTS:By 2010, the model predicts 103,500 individuals living with HIV in Haiti, of whom 27,300 were estimated to receive ART. Continuing ART initiation at current rates requires increasing the number on ART to 43,300 by 2020 (56% coverage), with 89,700 deaths estimated between 2010 and 2020. The number on ART could increase by 7400 (+17.1%, best case) or decrease by 25,600 (−59.1%, worst case), resulting in 19,500 deaths averted and 9900 fewer in care awaiting ART (best versus worst case). Results are sensitive to untreated disease progression and pre-ART loss from care. Increased HIV testing, linkage to care, and retention in care can avert additional deaths and achieve nearly 80% ART coverage with optimal policy improvements.
CONCLUSIONS:In resource-limited settings, continued improvements in HIV treatment access will save lives. Efforts to efficiently expand ART access should remain a global priority.