Washington D.C., USA, 22-27 July 2012 Estimating the Costs and Impacts of HIV/AIDS Programs for Botswana Examples of the ART Program and

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Estimating the Costs and Impacts of HIV/AIDS Programs for Botswana

Examples of the ART Program and Various Prevention Strategies

Presented by: Peter M. Stegman,Sr. Economist & Managing Director,

Futures Institute Southern Africa Office

ACHAP Symposium - International AIDS ConferenceWashington DC, USA

23rd July 2012


Botswana Background

• Despite its successes, Botswana still suffers one of the worst epidemics globally

• The national ART program has greatly curbed HIV-related mortality by achieving 90% coverage

• Prevention efforts, however, have not kept pace – accounting for less than 10% of total AIDS expenditure1

1National AIDS Coordinating Agency (2011), National Operational Plan for HIV and AIDS, GOB.


Some Limitations of study

• Study done in advance of release of important up-to-date data

• Completeness and currency of program data was sometimes a challenge

• Lack of data on CD4 progression rates and ART mortality by CD4 count at initiation


Spending for HIV and AIDS2

• Since the ‘90s the GoB has increased health spending

• By 2008 GoB was spending BWP 1.5bn ($ 220m) on HIV/AIDS annually

• Over the same period, donor funding also increased

• Currently GoB funds about 70% of national HIV/AIDS program

• Faced with scaled back donor funding, the global economic crisis and constrained domestic revenues, GoB is concerned about HIV/AIDS program sustainability

2National AIDS Coordinating Agency (2010), Botswana National AIDS Spending Assessment 2006-2008, GOB.


The ART Program in Perspective

• Program started in 2002 in four primary sites• By 2004 there was at least one treatment site

in each of the 27 health districts• Presently there are 32 ART sites and 212

satellite dispensing clinics across the country• At end of March 2012 there were just over

184,000 people on treatment• In 2010, the WHO recommended easing ART

initiation guidelines to levels <CD4 350


Modeling ART Guideline Change

• Created baseline projection in which ART initiation threshold was CD4 250

• Developed alternative scenario in which ART initiation threshold was relaxed to CD4 350

• In both scenarios coverage was held at 90%• The difference between the baseline and the

CD4 350 scenario produced counterfactual impacts and costs for the ART program to 2016


Estimated New & Existing ART Patients


Additional Eligible ART Patients Due to Guideline Change to CD4 350


Increased Care & Treatment Costs 20123

3Amounts for OI are marginal in either case and are therefore not visible here


Prevention Scenarios

• Baseline• CD4 350• High Impact Prevention• Universal Access


Number of New Infections by Scenario


Costs by Intervention & Scenario


Incremental Costs of Prevention ScenariosIndicator Baseline CD4 350 High Impact

PreventionUniversal Access

New Infections (2012-2016)

63,700 51,000 38,200 32,400

Infections Averted 12,700 25,600 31,300Total Cost in Millions of US$ (2012-2016)

$2,170 $2,430 $2,530 $2,750

Additional Cost in Millions of US$

$255 $360 $575

Cost-effectiveness per infection averted (excludes deaths averted)

$20,200 $14,000 $18,300

Incremental Cost-Effectiveness Ratio

$20,200 $7,900 $37,300


Incremental Costs of Prevention ScenariosIndicator Baseline High Impact

Prevention CD4 250

High Impact Prevention CD4 350

New Infections (2012-2016) 63,700 47,600 38,200

Infections Averted 16,200 25,600Total Cost in Millions of US$ (2012-2016)

$2,170 $2,270 $2,530

Additional Cost in Millions of US$ $100 $360

Cost-effectiveness per infection averted (excludes deaths averted)

$6,500 $14,000

Incremental Cost-Effectiveness Ratio $6,500 $7,900


Total Costs by Scenario 2012-2016


Conclusions

• Future benefits of raising ART initiation threshold to <CD4 350 for general population include infections averted and reduced HIV-related mortality

• Depending on the rate of increase in new ART patients, the MOH may be able to cope through “spike” period

• High impact prevention strategy is cost effective and averts infections, but without expansion of ART, the cost in avoidable HIV-related deaths may be much too high


This report was a collaborative effort between:

The conclusions and recommendations of this report are to provide the MOH and the

Government of Botswana with the evidence to make appropriate, informed decisions about the

pace and scope of treatment and prevention program scale-up

.

Ntwa e Bolotse


Thank You

Documents

Washington D.C., USA, 22-27 July 2012 Estimating the Costs and Impacts of HIV/AIDS Programs for Botswana Examples of the ART Program and