February 25, 2013
Two studies concluded that the program to fight HIV/AIDS in rural South Africa with expensive antiretroviral therapy (ART) has increased life expectancy and reduced the risk of HIV transmission to healthy individuals.
The analysis of a $10.8 million campaign in KwaZulu-Natal province showed that the drug scale-up was very cost-effective. The program was administered by nurses in rural health clinics in a poor region of approximately 100,000 people. Patients collected ART medications once a month from the clinic so they could take their daily ART doses. In 2003, the year before the program, 29 percent of all residents were HIV infected and AIDS was the cause of half of all deaths. Life expectancy was slightly more than 49 years. By 2011, life expectancy had increased to 60.5 years, according to Till Barnighausen, one of the researchers and a global health professor at the Harvard School of Public Health. Researchers used the increase in longevity to determine the number of years gained as a result of ART. They also used the number of years gained and the program's total expense to calculate the cost-effectiveness ratio of $1,593 per life-year saved.
World Health Organization (WHO) considers medical intervention to be highly cost-effective if the cost per year of life saved is lower than a nation's per capita gross domestic product (GDP). This program was below South Africa's 2011 per capita GDP of approximately $11,000. The research team also considered that the study period coincided with the arrival of electric power and clean water for the area, but felt that those two items could not explain the dramatic increase in longevity.
In a second study of the same region, researchers followed approximately 17,000 healthy individuals from 2004 to 2011 to investigate HIV infection rates in areas with active ART programs. Results showed that healthy residents were 38 percent less likely to contract HIV than those from areas without ART. Also, people in extremely rural areas did better than those in more closely populated areas clustered around national roads. HIV prevalence increased 6 percent during the seven years of the study. This was attributed to treatment allowing people with HIV infection to live longer.
The full report, "Increases in Adult Life Expectancy in Rural South Africa: Valuing the Scale-Up of HIV Treatment," was published in the journal Science (February 2013; 339 (6122): 961-965); and the full report, "High Coverage of ART Associated with Decline in Risk of HIV Acquisition in Rural KwaZulu-Natal, South Africa," was published in the journal Science (February 2013; 339 (6122):966-971).