Study: Universal testing and treatment in sub-Saharan Africa would pay off in education cost savings alone

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In April 2000, an education professor at the University of Zambia sized up the still growing impact of the HIV epidemic in sub-Saharan Africa and wrote: “Notwithstanding the catastrophic effects that are already being experienced, the full consequences of the pandemic are still to be felt. The storm has been gathering for two decades. In many of our countries, it has yet to break with full force.

“Some insight into what this apocalyptic scenario means for a social sector can be gleaned from an examination of the potential multiple effects of HIV/AIDS on education,” he added, “with special attention to the formal school system.”

The professor, Irish-born priest Father Michael J. Kelly, knew well the vital role that access to formal schooling played in strengthening a country. By then a citizen of Zambia, he had lived and worked in the country even before it attained freedom from British colonialists in 1964, and he had seen the importance of education in making the country truly independent. When AIDS came, education became more critical than ever, in the opportunities it offered to improve both living conditions and knowledge, but at the same time the education was having a devastating impact on schools: “In Zambia the education sector is carrying an unknown but large number of non-productive persons — teachers who are too ill to teach, but who must remain on the payroll.”

Click on image to enlarge: HIV positive teachers in 2009 by country, estimated in study, rounded to nearest 10

Now, not just the numbers, but the impact, and, in turn the cost of responding to that impact are better known, thanks to a recently released study, Economic Impact of HIV and Antiretroviral Therapy on Education Supply in High Prevalence Regions that brought together data from ministries of education in the regions of the world with the highest rates HIV prevalence  with UNAIDS data on HIV rates. The study’s conclusions, based on conservative estimates: Universal testing and treatment for teachers would greatly mitigate the direct financial impacts of the epidemic to education and in sub-Saharan Africa, where the prevalence of HIV was highest, universal testing and treatment would be an investment that would return nearly four times each dollar spent on testing and treatment that prevented a teacher’s death, in education costs alone. That is, the authors note, “even ignoring the additional and important health and social returns.”

The impact of education on lowering the probability of acquiring HIV has been demonstrated, as has the impact lack of education access has on increasing vulnerability to getting the virus,”especially for young girls and the women they become,” study author Dr. Claire Risley told Science Speaks. Using the UNAIDS estimates on numbers of HIV-positive people by age and year, as well as their need for treatment and numbers dying each year, with data on age, country and gender distribution of teachers collected from national education agencies, researchers also sourced numbers on costs related to absenteeism and death benefits. Mathematical modelling produced estimates on direct financial costs of testing and treatment, and the costs of HIV-related illnesses and deaths among teachers. The results of balancing those two financial impacts ranged from the estimate of a return of $3.99 on each of the $4,809 spent on each teacher’s death averted in sub-Saharan Africa, to the Caribbean estimates that a cost of $30,320 for each teacher’s death averted would return 64 cents on the dollar. Among the factors producing that range, Risley said, is that with lower HIV prevalence in Caribbean more teachers would necessarily be tested for testing to prevent one death, and the costs of treatment are higher there.

The study  however, looks at the overall impact of HIV to something called “education supply,” which reflects both quality and quantity, including pupil teacher ratio, and the capacity of education to deliver skills and meet goals. The impact of HIV on education supply can vary greatly by location as well — in remote villages where a school can depend on the well-being of one teacher, and where access to treatment is similarly limited, the epidemic’s impact becomes part of a vicious circle. That impact goes for smaller countries where teachers are scarcer as well.

The study, which has been made available to national ministries of health, uses 2008 antiretroviral drug prices as well as 2008 treatment guidelines.

“It would be lovely,” Risley said, to see a continued measurement of the impact of both HIV and responses to it on education.

“Large scale modelling can be really powerful,” she says. She would like to see an updated study, that uses current lower treatment prices, and factors in the value of universal testing and treating teachers in the setting of current economic realities that have increased competition for aid money.

“It’s a good contender,” she said. “It achieves both health and education.”




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