Table 1.

Impact of HIVDR Between 2016–2030^a

Scenario Until 2030	Of those on ART, Percent With Viral Load <1000 copies/ mL	AIDS Deaths (per year)b	HIV Incidence (adults 15–49)/100 PY	Cost of First- Line ART ($)b,c,d	Cost of Second- Line ART ($)b,c,d	Cost of Third- Line ART ($)b,c,d	Overall ART Cost ($)b,c,d
Current level of PDR <10% (mean ~ 5.7%)
(1) With HIVDR	89%	16 000	0.19	50M	21M	1.0M	72M
(2) Without further HIVDR	95%	14 000	0.17	55M	12M	0.7M	68M
Effect of HIVDR	6% Median 6% (5%–7%) lower viral suppression rate in those on ART	13% Median 12% (3%–23%) attributable to HIVDR	7% Median 8% (0%–23%) HIV incidence attributable to HIVDR	Lower cost of 1st-line drugs	Higher cost of 2nd-line drugs	Higher cost of 3rd-line drugs	6% Median 6% (2%–9%) of ART costs attributable to HIVDR
Current level of PDR ≥10% (mean ~ 15%)
(1) With HIVDR	85%	26 000	0.48	71M	38M	2.0M	111M
(2) Without further HIVDR	93%	22 000	0.43	79M	22M	1.4M	102M
Effect of HIVDR	8% Median 8% (6%–10%) lower viral suppression rate in those on ART	16% Median 16% (7%–25%) attributable to HIVDR	9% Median 9% (0%–26%) HIV incidence attributable to HIVDR	Lower cost of 1st-line drugs	Higher cost of 2nd-line drugs	Higher cost of 3rd-line drugs	8% Median 8% (4%–11%) of ART costs attributable to HIVDR

Abbreviations: ART, antiretroviral therapy; HIV, human immunodeficiency virus; HIVDR, HIV drug resistance; PDR, pretreatment HIV drug resistance; PY, person-years.

^aMean and, for effect of drug resistance, median; 90% range over model runs /situations. This is the projected average impact in the context of low income settings in sub–Saharan Africa with an adult population size of 10 million.

^bIn context of country with adult population size of 10 million.

^cDiscounted at 3% per year.

^dCosts of antiretroviral drugs (including 20% for supply chain) for first-line $120, second-line $343, and third-line $962. Other unit costs are shown in Supplementary Methods.