Resource Needs for Hiv/AIds

RESOURCE NEEDS FOR HIV/AIDS [Schwartlander B, et al. Science 2001;292:2434]: The authors review the UN General Assembly Special Session on AIDS, which took place in June of this year. This document identifies the goals for prevention and treatment of HIV in 135 low-and middle-income countries in 2005. Methods: Estimates of the HIV-infection rates were based on survey data. Availability of facility-based services for treatment, counseling, and testing was based on health-service coverage for tuberculosis treatment, immunizations, attended births, and prenatal care. Prevention interventions were based on HIV prevalence. The cost of HIV care was based on the following: (1) cost of OI treatment for the last 2 years of life; (2) OI prophylaxis for newly symptomatic persons; (3) HAART based on average survival assumed to be 5 years, with drug pricing according to per-capita gross national product; and (4) the cost of pediatric HIV assumed to be half that of country-specific adult costs. Revenue needed: It was estimated that by 2005, revenues needed will be $9.2 billion/year, which includes $4.4 billion for care and $4.8 billion for prevention. The breakdown by region for these two categories is provided in table 1 below:Table 1Prevention: Activities in this category include teacher training, distribution of male and female condoms, condom promotion and marketing, treatment of STDs, voluntary testing and counseling, transfusion screening, prevention of perinatal transmission, mass media campaigns, harm reduction, and peer counseling. The goal of this program would be to reach 22 million persons with prevention services, voluntary counseling, and testing for 9 million; 35 million pregnant women will be tested, and 900,000 will receive antiretrovirals. Other target populations include 6 million sex workers, 28 million gay men, and 3 million injection drug users. Medical care and support: The annual costs in U.S. dollars are summarized in table 2, which provides a broad range for drug costs for HAART because of variations based on assumed costs of drugs for low-income countries and higher for countries with a higher per-capita GNP.TABLE 2: Care and support/patientCurrent coverage: There is a broad range of coverage currently being provided, which includes 78% of “all patients in need” receiving HAART in Latin America to only 7% receiving HAART in the “weakest countries in Africa.” Source of revenue: The estimated need is $3.2 billion in 2002, $4.7 billion in 2003, $6.8 billion in 2004, and $9.2 billion in 2005. It is assumed that these resources will come from domestic and international sources, with contributions varying greatly according to GNP. International sources were identified as the source of funds for 80% of the need in Africa and South/Southeast Asia. Middle-income countries such as Brazil, Mexico, and Thailand will be expected to provide most of the necessary resources from domestic sources.