First the landmark HPTN 052 study proved what antiretroviral treatment can do to prevent transmission of HIV. Now, two studies reported in the most recent edition of the journal Science spell out what increased treatment coverage has done, in communities in the “real world” — among people going about their business, not receiving instructions of researchers, not necessarily in stable, committed, or exclusive sexual relationships, and getting medicine from a real public sector program. What the studies show, in lowered overall rates of HIV transmission in a place with one of the highest burdens of HIV on earth, and in overall longer life expectancy for adults in communities with increased coverage, has “real world” implications as well for global health policy, planning, and funding.
For High Coverage of ART Associated with Decline in Risk of HIV Acquisition in Rural KwaZulu-Natal, South Africa (access is free, with registration), researchers looked at rates of HIV acquisition in a subdistrict that was seeing a rapid scale-up of antiretroviral treatment. Defining antiretroviral treatment coverage as the proportion of all HIV-infected individuals receiving antiretroviral treatment, researchers looked at HIV incidence between 2004, when treatment of the first patients began, to 2011 when about 37 percent of all HIV infected adults were estimated to have been started on antiretroviral treatment. They found “a steep and highly significant decline in an individual’s adjusted HIV acquisition hazard with increasing ART coverage.” In short, a person who didn’t have HIV living in an area where 30 to 40 percent of people with HIV were receiving treatment was, on average, 38 percent less likely to get HIV than someone living in an area where less than 10 percent of HIV-infected people were receiving treatment. The drop in HIV acquisition risk was highest among those over 35 years old, which also was the age group among whom the greatest proportion of HIV-infected people were receiving treatment. The results, the authors conclude, indicate that with commitment to continued scale-up of treatment coverage, an overall reduction in HIV transmission can be accomplished through public sector treatment programs.
Increases in Adult LIfe Expectancy in Rural South Africa: Valuing the Scale-Up of HIV treatment (access free, with registration) begins with the observation that during the last century, until the impact of the global HIV epidemic in the late 1980s, life expectancy was on the rise through most of the world. The effects of shortened life expectancies — in some areas by as much as 15 years — over two decades between the recognition of AIDS and the availability of treatment in southern African countries — resulted in large numbers of orphans while taking a toll on education, skilled workforces, economic development. Looking at a group of 101,000 in KwaZulu-Natal, researchers compared life expectancies before and after the availability of antiretroviral treatment in the public health system in 2003. The societal value of the additional 11 years of life expectancy that came after the arrival of treatment, they found “far outweigh the costs of providing treatment.” The real world savings of uninterrupted lives, including fewer orphans and better returns on educational investments, they conclude, are numbers that policy makers and donors can factor into their decisions.