What is the best way of fighting AIDS?  What is the right balance to strike between health education, treatment of the disease and caring for AIDS sufferers? It is essential in developing countries where funds are scarce to find the most cost effective method of combating the disease.  The World Health Organisation (WHO), together with Copenhagen University, looked into the most effective methods of tackling the epidemic in Africa. 

The HIV virus causes 20 per cent of all deaths in Africa.  In the worst affected countries life expectancy has dropped by more than 10 years because of the epidemic while the social and economic consequences have been devastating. Treatment is now a higher priority for governments after the decrease in the cost of drugs.  However, access to treatment remains limited.

The World Development Report of 1993 suggests that a treatment costing less than US$ 50 for each year of life saved represents good value for money.  This figure is over US$ 60 in today’s prices. 

The study found that:

• Treating sexually transmitted diseases, providing condoms and blood screening cost only US$ 1 for each year of life saved.
• Other blood safety measures and preventing mother-to-child transmission (with single-dose nevirapine) cost as little as US$ 10 for each year of life saved.
• Tuberculosis treatment costs less than US$ 75.
• Other schemes, such as giving babies formula milk and home care programmes, cost several hundred dollars for each year of life saved.

Care is often given priority over prevention as the needs of the people infected with HIV are so great. However, it is equally important to prevent fresh infection. A WHO workshop identified key areas for the investment of the additional US$ 400 million a year provided by the Global Fund. It concluded that 750 000 more people could be treated and one million infections prevented.  This study states that:

• A shift of 10 per cent from treatment towards prevention would save many more lives.
• Prevention of HIV, together with treatment of tuberculosis, should be given priority.
• Care provided within a community can often be more cost-effective than when provided by a health centre.
• The most cost-effective of preventing mother to child transmission is to use single dose nevirapine. Providing formula milk is an expensive option.

The researchers conclude that preventing HIV infection is more cost-effective than providing treatment and care once the virus has been contracted.

Source(s):
‘Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence’, The Lancet 359: 1635-1642, by A. Creese et al, 2002 Full document.
'HIV prevention before HAART in sub-Saharan Africa', The Lancet 359: 1851-1856, by E. Marseille et al, 2002

id21 Research Highlight: 4 November 2003

Further Information:
Andrew Creese
Essential Drugs and Medicines Policy Department
World Health Organisation
Geneva
Switzerland

Contact the contributor: creesea@who.ch

World Health Organisation

University of Copenhagen, Denmark

Other related links:
'Model of success - universal access to treatment in Brazil' >

'Insights Health Editorial: Delivering the goods - HIV treatment for the poor' >

'Bigger AND better? Expanding community action on HIV/AIDS' >

'Taking aim – did UNGASS set an impossible goal?' >

See id21's collection of links relevant to HIV/AIDS.