Meeting Brochure and registration form      SMDM Homepage

Tuesday, October 23, 2007 - 8:45 AM
F-2

SCALING UP ANTIRETROVIRAL TREATMENT (ART) IN SOUTH AFRICA: SPEED AND SURVIVAL

Rochelle P. Walensky, MD, MPH1, Robin Wood, FCP, MMed, DTM&H2, Milton C. Weinstein, PhD3, Neil A. Martinson, MBBCh, MPH4, Elena Losina, PhD1, Mariam O. Fofana, AB1, Sue J. Goldie, MD, MPH3, Nomita Divi, MSc1, Yazdan Yazdanpanah, MD, PhD5, Bingxia Wang, PhD1, A. David Paltiel, PhD6, and Kenneth A. Freedberg, MD, MSc1. (1) Massachusetts General Hospital, Boston, MA, (2) University of Cape Town, Cape Town, South Africa, (3) Harvard School of Public Health, Boston, MA, (4) Johns Hopkins University, Baltimore, MD, (5) Centre Hospitalier de Tourcoing, Tourcoing, France, (6) Yale School of Medicine, New Haven, CT

Purpose: Projected ART scale-up scenarios call for 1.4 million people in South Africa to receive ART by 2008; only 21% of eligible patients receive ART now. Under alternative scale-up scenarios, our objectives were: 1) to anticipate the number of adults alive and on ART; 2) to project when/if treatment needs would be met; and 3) to quantify the expected number of lives lost while awaiting therapy from 2005-2010.

Methods: Using an HIV simulation model with natural history and treatment data from South Africa, we projected HIV-associated mortality rates with/without effective ART, for both a cohort of adults in need of therapy in 2005 (prevalent cohort, mean CD4 = 92/µl) and adults newly ART-eligible each year from 2006-2010 (incident cohort, mean CD4 = 210/µl). We examined 5 scale-up growth scenarios: 1) Zero (# of new ART slots available by 2010 = 750,000); 2) Constant (1.2 million); 3) Moderate (2.5 million); 4) Rapid (2.8 million); and 5) Full capacity (3.1 million). ART use included two sequential regimens of therapy with 48-week HIV RNA suppression of 89% and 70%. Mortality rates before and after ART initiation were obtained from model-based annual mortality rates with/without ART and WHO data on the number of eligible patients awaiting ART. In sensitivity analyses, we examined alternative prioritization schemes as well as ART options.

Results: Immediately available ART led to five-year survival rates in the prevalent and incident cohorts of 70% and 72%, compared to 1% and 4% without ART. Each additional ART slot increased mean HIV-survival by 6.5 years. By 2010, both the Moderate and Rapid scenarios fully met the ART need but the Zero and Constant scenarios fulfilled only 45% and 65% of that need. In 2010, these scenarios result in 693,000 and 2.6 million people alive and on therapy. Of all the scenarios examined, only the Rapid scenario provided ART to 1.4 million or more eligible patients by 2008. From 2005-2010, cumulative HIV-related deaths in South Africa ranged from 2.2 million in the Zero growth scenario to 1.2 million in the Rapid scenario.

Conclusions: Rapid ART scale-up in South Africa can make the difference in saving hundreds of thousands of lives in South Africa alone. Continued South African and international efforts to do this effectively are imperative.


See more of Concurrent Abstracts F: Simulation and Clinical Strategies
See more of The 29th Annual Meeting of the Society for Medical Decision Making (October 20-24, 2007)