If Prevention Targets Are Met, Cost Savings Will Pay for Expanded Treatment
Newswise — The first U.S. National AIDS Strategy "makes epidemiologic sense" and can meet its central goal of achieving a 25 percent reduction in the incidence of AIDS by 2015, according to an editorial in JAIDS: Journal of Acquired Immune Deficiency Syndromes. JAIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
Assuming that all targets are met—particularly for HIV prevention—the National AIDS Strategy "will substantially alter the epidemic in the United States," writes David R. Holtgrave, Ph.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore. However, he warns that the strategy will need to be fully funded and implemented to realize the projected health and economic benefits.
National AIDS Strategy Can Meet Its Ambitious Targets …Since the start of the HIV/AIDS epidemic, the United States has been in the "embarrassing situation" of having no comprehensive AIDS strategy, according to Dr. Holtgrave. "HIV prevention programs have been substantially underfunded for far too long, and sadly we cannot instantly reverse the epidemiologic damage of those years of policy neglect."
The centerpiece of the National AIDS Strategy is a 25 percent reduction in the incidence (newly diagnosed cases) of HIV in the U.S. populations by 2015. Other goals include reducing the HIV transmission rate by 30 percent and increasing the percentage of patients who know they are HIV-positive to 90 percent.
The 25 percent reduction in HIV incidence is an ambitious goal—but is it achievable? Mathematical projections suggest that the answer is yes, according to Dr. Holtgrave. The goals of the National AIDS Strategy have "logical consistency"—if all other goals are met, then the 25 percent target for reducing AIDS incidence would be met as well. In fact, if other goals were set more aggressively, even larger reductions might be possible.
…But Congressional Action Is Needed to Make Resources AvailableIf fully implemented, the National AIDS Strategy will prevent approximately 76,000 HIV infections through 2015, the projections indicate. What's more, meeting these targets will "alter the trajectory of the epidemic," averting a total of nearly 238,000 infections trough 2020. If goals for treatment strategy are met, about 219,000 additional patients will be in treatment by 2015, in the public sector alone.
However, these benefits depend on devoting the resources to make the National AIDS Strategy a reality. The total estimated cost is approximately $15 billion, of which $12 billion is for direct treatment and care. If the strategy is fully funded and prevention goals are met, then the public sector medical care costs saved will total approximately $18 billion, Dr. Holtgrave projects.
"Hence, the prevention elements of the NAS could avert enough new infections to 'pay for' the treatment expansion for persons now or very soon to be living with HIV under the status quo," he writes. Even further cost savings are likely in the years after 2015.
Dr. Holtgrave outlines the next steps in putting the National AIDS Strategy in place, highlighting the importance of ensuring that the program is fully funded by Congress. "Without Congressional action, this plan's chances for success are tremendously diminished," he writes. Without funding of all components, the nation will face the "grim reality" of continued increases in HIV/AIDS rates, as well as loss of the calculated economic benefits.
"However, if we can pull together to marshal the leadership, resources, and commitment to making the goals real, then the Strategy will have indeed changed the course of the HIV/AIDS epidemic in the United States," Dr Holtgrave concludes. "Lives (and coincidentally, financial resources) will be saved."
About JAIDSJAIDS: Journal of Acquired Immune Deficiency Syndromes (www.JAIDS.com) is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic science, clinical science, and epidemiology. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.
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