Additional $120B Needed to Meet Federal HIV/AIDS Goals by 2020

OCTOBER 18, 2017
Jared Kaltwasser
Rochelle Walensky, MD, HIV, Massachusetts General HospitalMeeting goals set forth in the National HIV/AIDS Strategy (NHAS) by 2020 would prevent 200,000 deaths and stop a quarter-million infections over the next 2 decades, according to a new study.

The United States’ NHAS goals, established in 2015, call for 90% of people infected with HIV to be aware of their infection and 80% of those infected to achieve viral suppression through antiretroviral therapy (ART) by 2020.

The new research makes the case that achieving the NHAS goals would make clinical and financial sense, meeting the government’s own cost-effectiveness standards despite the hefty price tag that would be associated with the effort.

Rochelle P. Walensky, MD, MPH, the report’s senior author, (pictured) said despite the public health benefits, there are a number of reasons to worry that the US won’t be able to marshal the resources and political will needed to meet the goals by 2020.

“I most definitely think that we are at risk for falling short on the resources required to achieve these goals,” Walensky, chief of the Division of Infectious Diseases, Massachusetts General Hospital, told MD Magazine. “Indeed, we project that an additional $120 billion will be needed over the next 20 years to achieve these goals, an estimated increase in budget of 23%.”

The study found that meeting the goals would cost about $645.7 billion over the next 2 decades, compared to the $525.3 billion price tag of simply continuing the current policies and pace.

Walensky said the study also comes at a time when proposals for healthcare reform have been “generally unsupportive” of people living with HIV. She noted that 6 members of the Presidential Advisory Council on HIV/AIDS resigned in June, citing concerns that the White House was not devoting attention to the disease.

If the goals of NHAS were met, the higher diagnosis and treatment rates would result in successful viral suppression in 72% of HIV/AIDS patients, compared to the current rate of 49%.

Total deaths from HIV/AIDS in the next 2 decades would shrink to 551,000, according to the study’s projections, a significant decrease from the 750,000 deaths that would result if current policies are maintained.

For black men who have sex with men (MSM), a high-risk group targeted for increased attention, the total projected number of deaths would drop even more sharply, from 110,000 to 65,000.

If the targets were met, they would improve quality of life at a cost ratio of $68,900 per quality-adjusted life year (QALY), easily meeting the US government’s cost-effectiveness target of $100,000 per QALY. Among black MSM, the cost ratio would be just $38,300 per QALY.

Aside from funding concerns, another major barrier to success is retaining patients in treatment. The current 2-year retention rate for patients on ART is 78% and it would need to increase to 89% to reach NHAS goals.

Walensky said there are a number of reasons retention can be a challenge. She said many HIV/AIDS patients “feel” well, and thus feel less motivation to stay on track with their medications.

“Layer on top of that background, competing needs frequently suffered by our patients — such as food and housing security, not to mention medication/copay expense — and it is easy to understand why adherence becomes less of a priority,” she said.

The study is titled, “The Clinical and Economic Impact of Attaining National HIV/AIDS Strategy Treatment Targets in the United States.” It was published Sept. 28 in The Journal of Infectious Diseases.

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