The Survival Benefits of Antiretroviral Therapy in South Africa
Open Access
- 3 December 2013
- journal article
- research article
- Published by Oxford University Press (OUP) in The Journal of Infectious Diseases
- Vol. 209 (4), 491-499
- https://doi.org/10.1093/infdis/jit584
Abstract
We sought to quantify the survival benefits attributable to antiretroviral therapy (ART) in South Africa since 2004. We used the Cost-Effectiveness of Preventing AIDS Complications-International model (CEPAC) to simulate 8 cohorts of human immunodeficiency virus (HIV)-infected patients initiating ART each year during 2004-2011. Model inputs included cohort-specific mean CD4(+) T-cell count at ART initiation (112-178 cells/µL), 24-week ART suppressive efficacy (78%), second-line ART availability (2.4% of ART recipients), and cohort-specific 36-month retention rate (55%-71%). CEPAC simulated survival twice for each cohort, once with and once without ART. The sum of the products of per capita survival differences and the total numbers of persons initiating ART for each cohort yielded the total survival benefits. Lifetime per capita survival benefits ranged from 9.3 to 10.2 life-years across the 8 cohorts. Total estimated population lifetime survival benefit for all persons starting ART during 2004-2011 was 21.7 million life-years, of which 2.8 million life-years (12.7%) had been realized by December 2012. By 2030, benefits reached 17.9 million life-years under current policies, 21.7 million life-years with universal second-line ART, 23.3 million life-years with increased linkage to care of eligible untreated patients, and 28.0 million life-years with both linkage to care and universal second-line ART. We found dramatic past and potential future survival benefits attributable to ART, justifying international support of ART rollout in South Africa.Keywords
This publication has 33 references indexed in Scilit:
- Cost-effectiveness of World Health Organization 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in ZimbabweClinical Infectious Diseases, 2012
- HIV Development Assistance and Adult Mortality in AfricaJAMA, 2012
- Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic ReviewPLoS Medicine, 2011
- Correcting for Mortality Among Patients Lost to Follow Up on Antiretroviral Therapy in South Africa: A Cohort AnalysisPLOS ONE, 2011
- The Clinical Impact and Cost-Effectiveness of Routine, Voluntary HIV Screening in South AfricaJAIDS Journal of Acquired Immune Deficiency Syndromes, 2011
- Patient retention in antiretroviral therapy programs up to three years on treatment in sub‐Saharan Africa, 2007–2009: systematic reviewTropical Medicine & International Health, 2010
- Mortality of Patients Lost to Follow-Up in Antiretroviral Treatment Programmes in Resource-Limited Settings: Systematic Review and Meta-AnalysisPLOS ONE, 2009
- Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studiesThe Lancet, 2009
- Scaling Up Antiretroviral Therapy in South Africa: The Impact of Speed on SurvivalThe Journal of Infectious Diseases, 2008
- Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic ReviewPLoS Medicine, 2007