Despite its high absolute cost, investment in HIV remains a "no-brainer" as it delivers significant health benefits, averts millions of deaths, and allows people to live healthier and fuller lives. HIV investments also deliver significant economic returns, allowing people to remain in school, remain employed, and earn an income. A recent report by Economist Impact estimated that every dollar invested into HIV in South Africa between 2022 and 2030 will deliver a return on investment of $7.
South Africa is grappling with a reduced budget for public spending due to lower-than-expected tax revenue and weak economic growth. The budgets for health and other social services are facing cuts, including a R1 billion reduction in financing for the country’s HIV response. Good planning and prioritization is essential to maximize the impact of the money we do have for HIV. The University of Witwatersrand’s Health Economics and Epidemiology Research Office (HE2RO) provides valuable insight into how spending can be allocated to maximize impact in its annual South African HIV Investment Case.
The total budget for South Africa’s HIV response sits at around R30 billion a year, including spending by the South African government, R7 billion from PEPFAR, and R1.4 billion from the Global Fund. While funding is limited and facing cuts in coming years, the current budget still provides room to scale-up several services and interventions required to put the country on track to end the HIV epidemic.
The 2023 HIV Investment Case considers the potential impact, cost-effectiveness, and affordability of scaling up existing interventions and introducing several new interventions to South Africa’s HIV response. New interventions considered in the case include the hiring of dedicated staff to improve ART linkage and retention and the rollout of long-acting HIV prevention injections (in the form of CAB-LA/long-acting cabotegravir).
Preliminary findings from the Investment Case show that condom provision remains the most cost-effective intervention in the toolbox of interventions available to combat HIV. The Department of Health currently distributes 1 billion condoms per year, and the Investment Case recommends that the department expand the provision of condoms to 1.3 billion per year. The introduction of a linkage intervention that helps more people diagnosed with HIV to start and stay on treatment is necessary to meet the country’s HIV targets and is both cost-effective and affordable.
South Africa is on track to exceed the target of ensuring 95% of adults with HIV know their status by 2030, thanks to widely available HIV testing services. However, the target is not being met for infants and children living with HIV, as only 76% will know their status by 2030 if the current interventions remain. To improve this figure, the Investment Case recommends expanding HIV testing for infants and children at 10 weeks and 18 months, which is cost-effective and affordable within available resources.
The model found that expanding testing to reach 95% of HIV-exposed infants at 10 weeks and 18 months could improve HIV diagnosis rates in children to 85% by 2030. With even more resources, only 88% of children with HIV will be diagnosed by 2030, meaning the 95% target will not be met.
To get 95% of diagnosed people on treatment, the Investment Case suggests that by 2030, 84% of adults who know their HIV status in South Africa will have started treatment. This requires a national rollout of an intervention focused on improving ART linkage and retention. The researchers modelled the impact of a national rollout of the Siyenza linkage programme, which they estimate would cost R1.7 billion a year.
However, the high cost of this intervention and its resulting boost in the numbers of people on treatment would provide little room for financing other important HIV interventions within the current budget. The HIV Investment Case's numbers contrast sharply with preliminary findings announced by the Human Sciences Research Council (HSRC), which estimates that in 2022, 91% of people diagnosed with HIV were on treatment.
Within current budget constraints, South Africa will not meet the target of reducing new infections by 90% (from 2010 levels) by 2030. This target could be achieved by 2033 if the current budget is allocated to maximize impact. With an unconstrained budget, the researchers estimate that the target of reducing HIV infection by 90% could be met by 2027.
This article is republished from Spotlight by Catherine Tomlinson. Click here to read the original article.
