Costs and Outcomes of HIV Treatment in South Africa

Project Description

Since 2003, international agencies and national governments have set ambitious targets for the delivery of effective care and treatment for HIV/AIDS in sub-Saharan Africa. South Africa has long had one of the highest rates of HIV infection in the world and the world’s largest population of HIV-positive adults and children. In April 2004, the National Department of Health launched a national HIV/AIDS treatment program, with the goal of providing access to antiretroviral therapy (ART), pre-ART care, and other related services to all HIV-positive South Africans. By 2013, more than two million patients were receiving ART through this program.

An essential input to designing and sustaining this national endeavor is accurate, up-to-date information about the costs and cost-effectiveness of treatment, for different patient populations and in a wide range of settings. Treatment is already consuming a large proportion of the national health budget, and, as in many countries, warnings have begun to emerge of an impending funding shortfall as both patient numbers and program quality increase. In 2005, the CGHD and its South African research partner, the Health Economics and Epidemiology Research Office (HE2RO), an affiliate of the University of the Witwatersrand in Johannesburg, began a set of related studies of the costs and outcomes of treatment for adults and children. Since then, results have been published of the cost-effectiveness of different adult and pediatric treatment delivery models and drug regimens, using primary, patient-level data from a range of treatment sites. The Costs and Outcomes of AIDS Treatment (COAT) Model used in several CGHD activities was developed as part of this project and provides an innovative way to combine epidemiological and economic data from a patient cohort to generate detailed cost-effectiveness estimates. The study team has also conducted cost-effectiveness analyses of clinical trials, including a comparison of nurse-managed versus doctor-managed adult ART and of early infant diagnosis and treatment.

This work helped program managers and policy makers to understand the current costs of treatment, evaluate the economic implications of proposed treatment guideline changes, and identify areas for potential savings. It also generated the parameters needed for the National AIDS Cost Model and other models commissioned by the South African government, international agencies, and PEPFAR to help plan for the future of the national HIV/AIDS program.

Project Details

Principal Investigator Sydney Rosen
Boston University Co-Investigators Alana BrennanGesine Meyer-Rath, Matthew Fox
Country(ies) South Africa
Dates of Research 2004–2013
Donor/Funder USAID_logo_square_150United States Agency for International Development (USAID)