Estimating the Future Costs of HIV/AIDS Treatment in South Africa

Project Description

South Africa is home to both the largest number of HIV-positive people in the world and the largest and most ambitious HIV/AIDS treatment program. By the end of 2009, close to a million South Africans were receiving ART (antiretroviral therapy) from hundreds of public sector health care facilities.Treatment was delivered by the government’s Department of Health and supported by a range of international donor agencies, local nongovernmental organizations, and research institutions.

In 2008, the success of the South African program, in terms of patient demand for treatment and the sheer numbers of patients in care, led to a budgetary crisis and a suspension of new treatment programs. To prevent such occurrences in the future, in March 2009, the South African Department of Health and National Treasury asked a CGHD team to model the future size and costs of the national treatment effort.

In collaboration with the CGHD’s local team in Johannesburg, the Health Economics and Epidemiology Research Office (HE2RO), and with support from the USAID Mission in South Africa, CGHD researchers built a model to estimate the annual expected costs of the program between 2010 and 2017 and evaluate proposed changes to treatment guidelines. The model used projections of the number of patients in need of treatment and the proportion actually receiving treatment, along with primary cost and outcome data from the CGHD’s own studies.

Using this model, we found that under the 2010 WHO treatment guidelines, patient numbers would more than double, and treatment cost almost triple, between 2010 and 2017. We also estimated that the additional cost could be more than offset by potential savings from task shifting from doctors to nurses and more flexible ARV procurement rules, allowing more competitive drug prices. This information allowed the South African government to adopt new ART guidelines in 2010 and helped produce a consensus among government, civil society, and donor agencies over future budgetary needs.

This model has been used to project the ART budget in South Africa for government every year since 2009, and a number of other guideline expansions have been based on it. It is currently one of the models used in the country’s HIV and TB Investment Case for which analysis was lead by the same team at HE2RO and CGHD. The Investment Case showed the costs and epidemiological impact of expanding both treatment and prevention interventions further, including meeting the UNAIDS 90/90/90 testing and treatment goals by 2020, and implementing Universal Testing and Treatment.

Project Details

Principal Investigator Gesine Meyer-Rath
Boston University Co-Investigators Alana BrennanMatthew FoxSydney Rosen
Country(ies) South Africa
Dates of Research 2009 – current