The 90 90 90 strategy to end the HIV Pandemic by 2030: Can the supply chain handle it?

Jamieson, David; Kellerman, Scott E.

doi:10.7448/ias.19.1.20917

Cited by 73 publications

(72 citation statements)

References 10 publications

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“…The higher CD4 counts probably led to better health and to the fewer clinic/laboratory visits and HIV‐related hospitalizations than seen in earlier time frames, thereby reducing these costs. The approach of early ART initiation and its resulting improved population health does have cost implications for the 90‐90‐90 and U = U agendas . With increased numbers of patients diagnosed, engaged, retained in care, and accessing ART with suppressed viral loads, total population costs of care increase.…”

Section: Discussionmentioning

confidence: 99%

Updated direct costs of medical care for HIV‐infected patients within a regional population from 2006 to 2017

2019

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Objectives The aim of the study was to reappraise the precise costs of HIV care and cost drivers, to determine the optimal tools for modelling costs for HIV care, and to understand the implications of changing medical management of HIV‐infected patients for both subsequent outcomes and health care budgets. Methods We obtained all drug, laboratory, out‐patient and in‐patient care costs for all HIV‐infected patients followed between 1 January 2006 and 31 December 2017 (2017 Cdn$). Mean cost per patient per month (PPPM) was used as the standard comparator value. Patients were stratified based on CD4 count: (1) ≤ 75, (2) 76–200, (3) 201–500 and (4) > 500 cells/μL. We determined the cost for only HIV‐related expenses. We compared current costs with costs previously reported for the same population. Results The number of HIV‐infected patients in care doubled from 2006 to 2017; total costs increased from $12.4 to $30.1 million, with antiretroviral (ARV) drugs accounting for 78.8% of costs by 2017. Out‐patient/laboratory costs declined from 12% to 8.5%, while in‐patient costs exhibited more annual variation. Mean PPPM costs increased from $1316 in 2006 to $1712 in 2014, declining to $1446 in 2017. Higher PPPM costs were associated with CD4 counts < 200 cells/μL. Costs have shifted. While the cost of ARV drugs increased by 32%, the costs of out‐patient and in‐patient services decreased by 80% and 71%, respectively. Most of the decrease for in‐patient costs was attributable to a substantial decrease in HIV‐related hospitalizations. Conclusions Although antiretroviral therapy (ART) provides immense benefits, it is not inexpensive. ARV drugs remain the largest cost driver. Hospital costs have remained low. Substantial costs of lifelong ART necessitate innovative, locally applicable strategies for ARV selection and use.

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Section: Discussionmentioning

confidence: 99%

Updated direct costs of medical care for HIV‐infected patients within a regional population from 2006 to 2017

2019

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“…We term this type of interventions as a global solution. For example, the 90-90-90 strategy promoted by the WHO is a global solution to end the HIV/AIDS epidemic [61,62]; the measures used to end the SARS epidemic is a global solution [11]; and the ongoing measures to control influenza [63,64] and malaria [45,65], and the measures taken by China, WHO and many countries in the world to control the new coronaviral epidemic started in China are also great examples of global solutions [66].…”

Section: The Concept Of Global Solutionmentioning

confidence: 99%

“…The impact of HIV/AIDS is global. Any HIV/AIDS studies regardless of their scope will be global as long as it contributes to the global efforts to end the HIV/AIDS epidemic by 2030 [61,62]. Lastly, an investigation of cardiovascular diseases (CVD) in a country, in Nepal for example, can be considered as global if the study is framed from a global perspective [44].…”

Section: Types Of Global Health Researchesmentioning

confidence: 99%

What is global health? Key concepts and clarification of misperceptions

Chen

Lucero‐Prisno

et al. 2020

glob health res policy

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The call for "Working Together to Build a Community of Shared Future for Mankind" requires us to improve people's health across the globe, while global health development entails a satisfactory answer to a fundamental question: "What is global health?" To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, indepth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word "global" in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multicountry and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of "international health" by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.

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“…In June 2016, the UN General Assembly adopted its Fast Track strategy, with the aim of ending the HIV epidemic by 2030 . These ambitious goals posed huge challenges to the capacity of health systems and to the constrained resources available .…”

Section: Introductionmentioning

confidence: 99%

Pepfar 3.0’s HIV testing policy in Côte d'Ivoire (2014 to 2018): fragmentation, acceleration and disconnection

Bekelynck

Assoumou²,

Danel³

et al. 2019

J Intern AIDS Soc

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IntroductionHIV Testing and Counselling (HTC) remains a key challenge in achieving control of the HIV epidemic by 2030. In the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) adopted targeted HTC strategies for populations and geographical areas most affected by HIV. We examine how Pepfar defined targeted HTC in Côte d'Ivoire, a country with a mixed HIV epidemic, after a decade of expanding HTC services.MethodsWe explored the evolution of HTC strategies through the Country Operational Plans (COP) of Pepfar during its phase 3.0, from COP 14 to COP 17 (October 2014 to September 2018) in Côte d'Ivoire. We conducted an analysis of the grey literature over the period 2014 to 2018 (Budget & Target Report, Strategic Direction Summary, Sustainability Index and Dashboard Summary, https://data.pepfar.gov). We also conducted a qualitative study in Côte d'Ivoire (2015 to 2018) using in‐depth interviews with stakeholders in the AIDS public response: CDC/Pepfar (3), Ministry of Health (3), intermediary NGOs (7); and public meeting observations (14).ResultsSince the COP 14, Pepfar's HIV testing strategies have been characterized by significant variations in terms of numerical, geographical and population targets. While the aim of COP 14 and COP 15 seemed to be the improvement of testing efficacy in general and testing yield in particular, COP 16 and COP 17 prioritized accelerating progress towards the “first 90” (i.e. reducing the proportion of people living with HIV who are unaware of their HIV). A shift was observed in the definition of testing targets, with less focus on the inclusion of programmatic data and feedback from field actors, and greater emphasis on the use of models to estimate and disaggregate the targets by geographical units and sub‐populations (even if the availability of data by this disaggregation was limited or uncertain); increasingly leading to gaps between targets and results.ConclusionsThese trials and tribulations question the real and long‐term effectiveness of annually‐revised, fragmented strategies, which widen an increasing disparity between the realities of the actors on the ground and the objectives set in Washington.

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The 90 90 90 strategy to end the HIV Pandemic by 2030: Can the supply chain handle it?

Cited by 73 publications

References 10 publications

Updated direct costs of medical care for HIV‐infected patients within a regional population from 2006 to 2017

Updated direct costs of medical care for HIV‐infected patients within a regional population from 2006 to 2017

What is global health? Key concepts and clarification of misperceptions

Pepfar 3.0’s HIV testing policy in Côte d'Ivoire (2014 to 2018): fragmentation, acceleration and disconnection

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