Table 2.
Clinical and economic outcomes of programmatic cuts to HIV programs in the Republic of South Africa and Côte d’Ivoire at 10 years.*
| Strategy | Republic of South Africa* | Côte d’Ivoire* | ||||||
|---|---|---|---|---|---|---|---|---|
| Transmissions | Deaths | Years of Life | Budget, $M | Transmissions | Deaths | Years of Life | Budget, $M | |
| Current Standard | 3,240,000 | 4,258,000 | 63,957,000 | 32,180 | 225,000 | 270,000 | 4,234,000 | 1,500 |
|
| ||||||||
| Individual Cost-Containment Strategies Considered† | Additional Transmissions | Additional Deaths | Years of Life Lost | Budget Savings, $M‡ | Additional Transmissions | Additional Deaths | Years of Life Lost | Budget Savings, $M‡ |
|
| ||||||||
| No New ART | 630,000 | 1,664,000 | 8,518,000 | 7,740 | 24,000 | 93,000 | 479,000 | 420 |
| Late Presentation | 470,000 | 945,000 | 4,765,000 | 4,290 | 12,000 | 40,000 | 210,000 | 200 |
| ART 0.350*109 cells/L | 213,000 | 91,000 | 364,000 | 50 | 3,000 | 2,000 | 8,000 | 10 |
| Reduced Retention | 188,000 | 308,000 | 1,289,000 | 1,040 | 8,000 | 16,000 | 66,000 | 110 |
| No VL | 206,000 | 46,000 | 132,000 | −320 | - | - | - | - |
| No 2nd-line ART | 38,000 | 31,000 | 104,000 | 50 | 1,000 | 2,000 | 7,000 | 30 |
|
| ||||||||
| Combination Cost-Containments Strategies Considered† | Additional Transmissions | Additional Deaths | Years of Life Lost | Budget Savings, $M‡ | Additional Transmissions | Additional Deaths | Years of Life Lost | Budget Savings, $M‡ |
|
| ||||||||
| Late Presentation, ART 0.350*109 cells/L | 493,000 | 959,000 | 4,842,000 | 4,310 | 13,000 | 41,000 | 212,000 | 200 |
| Late Presentation, Reduced Retention | 608,000 | 1,168,000 | 5,748,000 | 5,120 | 18,000 | 53,000 | 264,000 | 290 |
| ART 0.350*109 cells/L, Reduced Retention | 390,000 | 395,000 | 1,623,000 | 1,050 | 11,000 | 17,000 | 72,000 | 110 |
| Late Presentation, ART 0.350*109 cells/L, Reduced Retention | 629,000 | 1,181,000 | 5,791,000 | 5,140 | 20,000 | 53,000 | 266,000 | 290 |
| No VL, No 2nd-line ART | 234,000 | 69,000 | 227,000 | −80 | - | - | - | - |
Abbreviations: ART: antiretroviral therapy; M: million
*
In 2016: RSA: 6.7 million HIV-infected (prevalence 19.2%); CI: 440,000 HIV-infected (prevalence 3.2%).
†
Each strategy is compared with the Current Standard, generally resulting in more transmissions and deaths and less years of life and costs accrued.
‡
Negative numbers in the Budget Savings column denote that this strategy increases, rather than decreases, costs.