In 2008, Reuben Granich and his colleagues at the World Health Organization published a paper in the medical journal The Lancet that proposed a new strategy for combating HIV in South Africa, a country staggered by the virus, with as much as 18 percent of the population estimated to be infected.
Based on a mathematical model, the study suggested a "test-and-treat" strategy. This would involve, among other steps, testing the entire population of South Africa for HIV and immediately beginning anti-retroviral therapy for all who tested positive. The current standard of care calls for waiting until symptoms appear after diagnosis.
Such a test-and treat strategy, the authors suggested, could eventually lead to the elimination of HIV in South Africa within a decade. Since then, the utility and feasibility of this approach have been widely debated, and it remains the leading potential prevention strategy for South Africa.
One aspect of the proposal that has not been examined, however, is the strategy's full estimated cost. Now, UCLA researchers have done their own modeling study and found that the costs have been substantially underestimated.
Reporting in the current online edition of The Lancet, Sally Blower, director of UCLA's Center for Biomedical Modeling and a member of the UCLA AIDS Institute, and Bradley Wagner, a postdoctoral scholar in Blower's lab, used their own sophisticated modeling techniques to duplicate the estimated cost curve used in the WHO report. They found that key potential costs including the expense of annual testing for a population of 32 million, the implementation of prevention programs and the "ramping up" of a health infrastructure that is currently overwhelmed were not included in the proposed approach.
Because the WHO did not disclose what costs they included in their estimates, Blower said, the UCLA researchers reconstructed it on their own. Using their own mathemati
|Contact: Mark Wheeler|
University of California -- Los Angeles