AIDS care for Africa affordable
In response to recent calls for action from African leaders, more than 100 faculty members from Harvard University signed the document “Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries” today.
The Statement outlines parameters for making antiretroviral therapy immediately available to poor countries, while at the same time conducting carefully controlled clinical trials in order to determine the best practices for providing HIV therapy in resource-poor settings. Included in the statement is a detailed cost estimate for delivering antiretroviral therapy as well as a proposal for how this treatment could be readily financed by resource-rich nations. The statement is the first of its kind to outline a comprehensive approach to counter the increasing global inequities in HIV treatment.
The statement calls upon wealthy countries, in partnership with poor countries, to establish a global HIV/AIDS Prevention and Treatment Trust Fund to provide both the scientific and financial leadership to make life-prolonging antiretroviral therapy available in the areas of the world hardest hit by the epidemic. The statement envisions that the trust fund would be established with joint leadership of the World Health Organization and UNAIDS, and with strong support from international scientific institutions including the National Institutes of Health and the Centres for Disease Control.
At the beginning of this “blueprint for action,” the Statement’s signatories note:
“We believe that the objections to treatment with antiretroviral therapy are not justified, partly because of changing circumstances such as falling prices of antiretroviral drugs and partly because obstacles to treatment such as poor infrastructure can be overcome through well-designed and well-financed international efforts.”
“The HIV epidemic is a global catastrophe,” says Dr. Bruce D. Walker, Professor of Medicine at Harvard Medical School, and one of the Statement’s signatories. “It is compounded by tremendous inequalities in care that must be dealt with now, not only for moral and ethical reasons, but also because of political, social, and economic imperatives. It is time for a response, and this Statement is intended not only to intensify discussion of feasible solutions, but also to prompt immediate action.”
The statement outlines specific examples of countries where highly active antiretroviral therapy (HAART, a “cocktail” of three or more anti-HIV medications) has been successful, noting successes even in resource-poor countries. Programs in Haiti, Senegal and Uganda are among examples noted, which have demonstrated that HAART can be effective when implemented with long-term commitment and international partnership.
The blueprint creates a target of having at least 1 million AIDS patients in Africa receiving antiretroviral therapy within three years, at a cost of about $1.1 billion per year. Additional costs of prevention programs and treatment other than antiretroviral therapy would require $3 billion per year, according to estimates of the UNAIDS international partnership, for an annual total of around $4.1 billion for both prevention and treatment. Assuming three million people in Africa are brought under treatment by the fifth year, total costs for prevention and treatment would rise to around $6.3 billion per year.
“In 2001, the prices of medications have continued to fall rapidly,” says Jeffrey Sachs, director of the Center for International Development at Harvard University. “Even though antiretroviral drug prices have declined to around $500 per year, this is still far above what poor countries can afford without donor assistance. Considering the combined $25 trillion gross national products of the high-income nations, the proposed donor support for treatment is a modest sum that will produce enormous economic, social, and political benefits for the world’s poor countries hard hit by the pandemic.”
The statement proposes not only a more widespread treatment approach, but also calls for carefully designed clinical trials to determine the best practices for delivering HIV therapy in resource poor settings. “There is no question that HIV therapy is cost-effective in wealthy countries” says Dr. Kenneth A. Freedberg of Harvard Medical School, “and it can clearly save lives in poor countries in a cost-effective manner if administered properly. With this Statement, we propose a series of scientifically sound clinical trials to answer the most important questions facing us in this endeavour, including issues related to drug delivery, efficacy, monitoring, and the development of antiretroviral drug resistance.” The plan also proposes designing targeted pilot programs that contribute directly to preventing the spread of infection, such as the inclusion of HIV-infected pregnant women and other groups with high risk of transmission. Effective treatment can not only reduce deaths and the disease’s accompanying opportunistic infections, but it can also play a major role in prevention by reducing the viral load and encouraging greater participation in prevention programs. Treatment options provide incentive for individuals to take an HIV test, thus becoming an important tool in AIDS prevention.
“This document has the potential for enormous impact on global health policy,” says Richard Marlink, executive director of the Harvard AIDS Institute. “As a result of widespread discussions within our academic community and with our African partners, individual faculty members involved in the HIV epidemic have decided to speak with one voice in addressing the increasing global need for AIDS treatment. The varied roles of the signatories in the struggle against AIDS – physicians, virologists, immunologists, epidemiologists, economists, human rights experts, and others – contributes to the strength of the document and the chances of success of the proposed plans.”