Predicting the Epidemiological Impact of Antiretroviral Allocation Strategies in KwaZulu-Natal: The Effect of the Urban-Rural Divide

Sally Blower of the University of California-Los Angeles and colleagues used computer based models and assessed three potential antiretroviral drug allocation programs in the South African province of KwaZulu-Natal to determine which strategy would prevent the largest number of new HIV infections and deaths from AIDS-related illnesses, Reuters reports (Fox, Reuters, 9/12). The study, which was published in the Proceedings of the National Academy of Sciences, finds that out of the three strategies -- one providing antiretrovirals only to the city of Durban and two others that would make them available in both urban and rural areas -- the "city-only" program would have the greatest impact on the epidemic, reducing the number of new HIV infections by 46%, or 15,000 new HIV cases, by 2008 (Xinhua/People's Daily, 9/12). In addition, in the city-only program, deaths from AIDS-related illnesses would decrease by 42% by 2008, the study finds. According to the researchers, if antiretrovirals were shared between Durban and rural areas, new HIV infections would fall by 11% to 28% in the city and 17% to 37% in rural areas (Reuters, 9/12). According to Blower, the city-only approach is the most effective, but "you can't have the maximum impact on the epidemic and be ethical." She added that a city-only antiretroviral provision program would lead to greater urban-rural health care disparities (Xinhua/People's Daily, 9/12).

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