Dr. Rochelle Walensky, an associate professor of medicine at Harvard Medical School and an expert in epidemiology and outcomes research, took on two of the most contentious issues in the current debate about HIV treatment scale up: Can we afford it? And why shouldn’t we shift attention to other global health priorities, such as maternal and child health.
Dr. Walensky began her talk by noting that literally millions of lives are at stake if HIV testing and treatment uptake is not ratcheted up at the promised pace. As it is, she said, most patients in sub-Saharan Africa and other parts of the developing world do not access treatment until very late, when they are already have extremely low CD4 counts and are very ill.
Referring to the recent change in WHO guidelines to initiate ART earlier, especially where TB is rampant, Dr. Walensky pointed to an analysis that she and others did showing the impact of such a move would avert more than a quarter of a million deaths and more than 200,000 opportunistic infections, including TB infections.
In another analysis, she and others looked at ART scale up over a five year period, from 2007 to 2012. They determined that if there was zero growth in ART access, that would result in 2.4 million AIDS-related deaths in South Africa alone over five years. Rapid growth in treatment rollout, by contrast, would mean another 1.2 million people alive over that period. In 2010, halfway through her timeline, she noted, scale up is somewhere between zero growth and constant growth, a level that would lead to 2.16 million deaths.
On the hot-button issue of “cost-effectiveness,” Dr. Walensky noted that routine HIV screening, access to lifesaving drugs in resource-limited settings, and earlier initiative of ART would all save vast amounts of money in the long term and are extremely cost effective.
As for a shift in US global health priorities away from AIDS and toward child and maternal health, Dr. Walensky said “detection and treatment of HIV is at the very core” of child and maternal health and there “should be nothing contentious about these synergistic health goals.” Access to HIV treatment means prevention of mother-to-child HIV transmission, so babies are born HIV free. It also allows for safe breastfeeding, which in turn reduces the likelihood of childhood diarrhea, which is associated with contaminated water used in formula feeding. And, she said, “it keeps mothers alive,” preventing orphanhood and their associated ten-fold risk of death.
In conclusion, she said, “the lifesaving benefits of ART in HIV disease are greater than virtually any other adult disease.” And these benefits can be significantly increased through wider access to HIV testing and diagnosis, earlier access to HIV treatment, and improved drugs.