Document Detail


Lives saved by expanding HIV treatment availability in resource-limited settings: the example of Haiti.
MedLine Citation:
PMID:  23535289     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Guidelines recommend antiretroviral therapy (ART) initiation at CD4 <350 cells per microliter for HIV-infected individuals in resource-limited settings. However, funding for treatment expansion remains uncertain. We forecast the mortality impact of ART expansion alternatives in Haiti.
METHODS: We used data from Haiti to develop a country-specific model of HIV disease. The model projects the mortality, total number of HIV-infected individuals, and number and coverage (percentage of those eligible) on ART by simulating cohorts of HIV-infected individuals over 10 years. Five ART expansion scenarios, ranging from fully expanded ART (best case) to No New ART (worst case), were assessed.
RESULTS: By 2010, the model predicts 103,500 individuals living with HIV in Haiti, of whom 27,300 were estimated to receive ART. Continuing ART initiation at current rates requires increasing the number on ART to 43,300 by 2020 (56% coverage), with 89,700 deaths estimated between 2010 and 2020. The number on ART could increase by 7400 (+17.1%, best case) or decrease by 25,600 (-59.1%, worst case), resulting in 19,500 deaths averted and 9900 fewer in care awaiting ART (best versus worst case). Results are sensitive to untreated disease progression and pre-ART loss from care. Increased HIV testing, linkage to care, and retention in care can avert additional deaths and achieve nearly 80% ART coverage with optimal policy improvements.
CONCLUSIONS: In resource-limited settings, continued improvements in HIV treatment access will save lives. Efforts to efficiently expand ART access should remain a global priority.
Authors:
April D Kimmel; Macarthur Charles; Marie-Marcelle Deschamps; Patrice Severe; Alison M Edwards; Warren D Johnson; Daniel W Fitzgerald; Jean W Pape; Bruce R Schackman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  63     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-13     Completed Date:  2013-07-08     Revised Date:  2014-10-02    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e40-8     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Acquired Immunodeficiency Syndrome / drug therapy*,  economics,  mortality
Anti-HIV Agents / economics*,  therapeutic use*
Antiretroviral Therapy, Highly Active / economics
CD4 Lymphocyte Count
Developing Countries / economics*
Disease Progression
Forecasting
Haiti
Health Resources / economics,  trends
Healthcare Financing
Humans
Markov Chains
Treatment Outcome
Grant Support
ID/Acronym/Agency:
D43 TW000018/TW/FIC NIH HHS; D43 TW000018/TW/FIC NIH HHS; K23 AI073190/AI/NIAID NIH HHS; K23 AI073190/AI/NIAID NIH HHS; K24 AI098627/AI/NIAID NIH HHS; K24 AI098627/AI/NIAID NIH HHS; KL2 TR000057/TR/NCATS NIH HHS; U2R TW006901/TW/FIC NIH HHS; U2R TW006901/TW/FIC NIH HHS; UM1 AI069421/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

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