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Resource
Needs for HIV/AIDS
[Schwartlander B et
al. Science 2001; 292: 2434]: The authors review the UN General
Assembly Special Session on AIDS which took place in June of this
year. This document identifies the goals for prevention and treatment
of HIV in 135 low and middle-income countries in 2005.
Methods: Estimates of the HIV-infection rates were based
on survey data. Availability of facility-based services for treatment,
counseling and testing was based on health service coverage for
tuberculosis treatment, immunizations, attended births and prenatal
care. Prevention interventions were based on HIV prevalence. The
cost of HIV care was based on: 1) cost of OI treatment for the last
two years of life, 2) OI prophylaxis for newly symptomatic persons,
3) HAART based on average survival assumed to be five years, with
drug pricing according to per-capita gross national product and
4) the cost of pediatric HIV assumed to be one half that of country-specific
adult costs.
Revenue Needed: It was estimated that by 2005, revenues needed
will be $9.2 billion/year, which includes $4.4 billion for care
and $4.8 billion for prevention. The breakdown by region for these
two categories is provided in the table below:
| Region |
Projected
Expenditures
($ millions) |
| Prevention |
Care/Support |
| Sub-Saharan
Africa |
$1560 |
$3070 |
| South
& SE Asia |
$1440 |
$670 |
| East
Asia, Pacific |
$810 |
$80 |
| Latin
America, Caribbean |
$590 |
$550 |
| Eastern
Europe, Central Asia |
$250 |
$20 |
| N.
Africa, Middle East |
$160 |
$50 |
| TOTAL |
$4810 |
$4440 |
Prevention:
Activities in this category include teacher training, distribution
of male and female condoms, condom promotion and marketing, treatment
of STDs, voluntary testing and counseling, transfusion screening,
prevention of perinatal transmission, mass media campaigns, harm
reduction and peer counseling. The goal of this program would be
to reach 22 million persons with prevention services, voluntary
counseling and testing for 9 million; 35 million pregnant women
will be tested, and 900,000 will receive antiretrovirals. Other
target populations include 6 million sex workers, 28 million gay
men, and 3 million injection drug users.
Medical Care and Support: The annual costs in U.S. dollars
are summarized in the following table, which provides a broad range
for drug costs for HAART due to variations based on assumed costs
of drugs for low-income countries and higher for countries with
a higher per-capita GNP.
|
Care
and Support/Patient ($USD)
|
| Category |
Annual
Cost |
| HIV
diagnostic tests |
$3 |
| Palliative
care (lifetime) |
$75 |
| OI
Rx (lifetime) |
$300 |
| OI
Prophylaxis |
$32 |
| HAART |
$450
- 3500 |
| Lab
monitoring HAART |
$140 |
| Orphanage
care |
$416 |
| Orphan
living assistance |
$58 |
| Orphan
school assistance |
$25 |
Current Coverage:
There is a broad range of coverage currently being provided, which
includes 78% of "all patients in need" receiving HAART in
Latin America to only 7% receiving HAART in the "weakest countries
in Africa".
Source of Revenue: The estimated need is $3.2 billion in 2002,
$4.7 billion in 2003, $6.8 billion in 2004 and $9.2 billion in 2005.
It is assumed that these resources will come from domestic and international
sources, with contributions varying greatly according to GNP. International
sources were identified as the source of funds for 80% of the need
in Africa and South/Southeast Asia. Middle-income countries such as
Brazil, Mexico, and Thailand will be expected to provide most of the
necessary resources from domestic sources.
posted
7/17/2001
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