There will be a significant shortfall in the funding needed for HIV control in sub-Saharan Africa in the coming years and those countries with the highest HIV burden will be unable to meet their obligations on their own to sustain control efforts, according to a new study by researchers at Harvard TH Chan School of Public Health. According to a Medical Xpress report, they calculate that the price tag for providing long-term HIV/Aids prevention and treatment in 2015-2050 in the nine sub-Saharan countries most affected by the epidemic ranges from $98bn at current coverage levels to $261bn if coverage is scaled up.
“The HIV epidemic is far from over,” said first author Rifat Atun, professor of global health systems. “The magnitude of funding needed to sustain the HIV fight is very large and the consequences of complacency even larger.”
Atun and colleagues looked at the nine countries that account for 70% of the HIV burden in Africa – Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. They modelled these countries’ HIV/Aids funding needs through 2050, based on four different scenarios of coverage levels, using data from Spectrum, a publicly available tool used by UNAIDS.
They found that scaling up HIV/Aids prevention and expanding antiretroviral treatment to all HIV-positive individuals would cost $261bn. The researchers say that “front-loading” investments now will be necessary to ensure that higher levels of coverage are achieved. This would ultimately reduce HIV transmission and future funding obligations.
Domestic financing, the most important source of funding for HIV, will not be sufficient to meet future obligations, so new, innovative sources of funding will be necessary to both maintain and expand treatment and prevention.
“The problem of predictable and sustainable funding must be resolved,” said Atun. He is quoted in the report as saying that, “there is an ethical responsibility to continue financing for those receiving ART, and not abandon them to death.”
Objectives: To estimate the present value of current and future funding needed for HIV treatment and prevention in 9 sub-Saharan African (SSA) countries that account for 70% of HIV burden in Africa under different scenarios of intervention scale-up. To analyse the gaps between current expenditures and funding obligation, and discuss the policy implications of future financing needs.
Design: We used the Goals module from Spectrum, and applied the most up-to-date cost and coverage data to provide a range of estimates for future financing obligations. The four different scale-up scenarios vary by treatment initiation threshold and service coverage level. We compared the model projections to current domestic and international financial sources available in selected SSA countries.
Results: In the 9 SSA countries, the estimated resources required for HIV prevention and treatment in 2015–2050 range from US$98 billion to maintain current coverage levels for treatment and prevention with eligibility for treatment initiation at CD4 count of <500/mm3 to US$261 billion if treatment were to be extended to all HIV-positive individuals and prevention scaled up. With the addition of new funding obligations for HIV—which arise implicitly through commitment to achieve higher than current treatment coverage levels—overall financial obligations (sum of debt levels and the present value of the stock of future HIV funding obligations) would rise substantially.
Conclusions: Investing upfront in scale-up of HIV services to achieve high coverage levels will reduce HIV incidence, prevention and future treatment expenditures by realising long-term preventive effects of ART to reduce HIV transmission. Future obligations are too substantial for most SSA countries to be met from domestic sources alone. New sources of funding, in addition to domestic sources, include innovative financing. Debt sustainability for sustained HIV response is an urgent imperative for affected countries and donors.