Michael Carter for Aidsmap (26 August 2010)
Lives will be saved if the US’s National AIDS Strategy (NAS) is properly financed and implemented, Dr David Holtgrave argues in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Although an additional $15 billion is needed to achieve the strategy’s goals, this would be more than offset by cost saving arising from reduction in the number of new HIV infections.
The NAS was launched at the White House by President Obama in July. It includes a number of ambitious targets which are to be achieved by 2015.
· Reducing HIV incidence by 25%.
· Reduce the HIV transmission rate by 30%.
· Increase the proportion of individuals with HIV whose infection has been diagnosed to 90%.
· Ensure that 85% of individuals diagnosed with HIV are linked to care within three months.
· Increase to 80% the proportion of patients who have two follow-up appointments.
· Increase to 86% the proportion of patients in permanent housing.
· Increase by 20% the proportion of gay/bisexual, black and Latino patients who have an undetectable viral load.
Holtgrave, who serves on the Presidential Advisory Council on HIV/AIDS (PACHA) and conducted research that helped inform the strategy, described its epidemiological goals as “bold”.
Nevertheless, he believes that a 25% reduction in incidence can be achieved. But this is dependent on all the other goals set by the strategy being achieved. Moreover, it also needs the number of HIV-negative partners of HIV-positive individuals to be reduced by 10%.
Achieving the strategy’s epidemiological goals could, Holtgrave believes, alter the course of the HIV epidemic in the US.
“Approximately 75,800 new infections will be prevented through 2015. What is more, achieving the goals of NAS helps to alter the trajectory of the epidemic such that even more infections could be averted in 2016 through 2020”, writes the author. “If the goals of the NAS are achieved, then the US epidemic will be very different than if the NAS simply is put on the shelf.”
But Holtgrave estimates that the strategy requires investment of $15.175 billion, $2 billion of which would go to fund cash-starved prevention services.
The potential savings that arise from this investment could be huge. Holtgrave comments: “If the prevention element is indeed fully funded and meets the NAS prevention goals, then the public sector medical care costs saved by averting new infections tally approximately $17.981 billion”, with further savings accruing thereafter.
Looking ahead, Holtgrave sets six priorities to ensure that the NAS’s goals become a reality:
· Conduct more modeling.
· Review implementation plans to ensure that they are based on sound research.
· Address knowledge gaps.
· Monitor Congregational action.
· Ensure local action accords with national goals.
· Treat the strategy as a living document which is regularly reviewed.
The alternative to action is described by the author as “grim”, with annual HIV incidence in the US topping 74,000 by 2015.
“However, if we can pull together to marshal the leadership, resources, and commitment to making the goals a reality, then the Strategy will have indeed changed the course of the HIV/AIDS epidemic in the US”, concludes the author “lives (and coincidentally, fiscal resources) will be saved.”
On the epidemiologic and economic importance of the National AIDS Strategy for the United States.
David R Holtgrave PhD
Journal of Acquired Immune Deficiency Syndromes August 26, 2010 - Published Ahead of Print doi: 10.1097/QAI.0b013e3181f4107a.
Link to JAIDS citation