guardian.co.uk,
Sarah Boseley, health editor, Friday 20 July 2012
 |
Bill
Clinton with school pupils in Matugga, Uganda. The former US president
has
hailed the results of the Clinton Foundation study. Photograph:
Kasamani
Isaac/AFP
|
Lack of
money can no longer be considered a reason – or an excuse – for failing to
treat all those with HIV who need drugs to stay alive, following game-changing
work about to be published by the Clinton Foundation that shows the real cost
is four times less than previously thought.
The
striking findings of a substantial study carried out in five countries of
sub-Saharan Africa are hugely important and will set a new hopeful tone for the
International Aids Conference in Washington DC, which opens on Sunday. It will
help make the argument for President Obama and other international donors to
dig deeper into their pockets – because the cost of saving lives, slowing the
spread of HIV and achieving the ambition of an Aids-free world is lower than
anyone assumed.
The work by
the Clinton Health Access Initiative (CHAI) shows that the total cost of
treatment in health facilities – including drugs, lab tests, health workers'
salaries and other overheads – comes to an average of $200 a patient a year
across Ethiopia, Malawi, Rwanda and Zambia – four of the Aids-hit African
nations studied. That rises to $682 in South Africa, which has higher salaries
and lab costs.
Until now
the generally accepted total cost of treating a patient for a year was an
average of $880 – based on a study by the US president's emergency plan for
Aids relief (Pepfar) released at the last International Aids Conference two
years ago in Vienna.
Bernhard
Schwartländer, director of strategy at UNAIDS, believes the CHAI work should
lead to new optimism. "I think the cost argument is just a false argument
and it has been used as an escape. We do need more money but it is not at a
level that will be impossible," he said.
The
costings are particularly important in the wake of recent scientific findings
that show putting people on antiretroviral drugs makes them far less likely to
infect others – helping to stop the spread of HIV as well as keeping people
alive. CHAI will also announce that it has negotiated down the prices of some
of the newer and most important drugs needed for treatment by around a third.
Former US
president Bill Clinton hailed the findings as evidence that all 15 million
people with HIV in need of treatment could affordably get it — the target for
2015. At the moment, 8 million are being treated. "We now have compelling
evidence that universal access to high-quality HIV treatment is achievable,
sustainable, and within our means," said Clinton.
"Together,
the costing study and price reductions open the door to scaling up and
sustaining services for the 7 million people who currently lack access to HIV
treatment. Providing treatment will save lives and help prevent the spread of
HIV."
CHAI worked
with the Centre for Global Development and the governments of those African
countries involved to collect data from 161 health facilities for the last
financial year on record – mostly 2010.
The
original aim of the study was to find out whether there was any potential to
reduce waste, cut costs and save money, but researchers found salaries and
other costs were already so low that this was unlikely, except possibly in
South Africa.
Average
costs per patient were lowest in Malawi, at $136 a year. That rose to $186 in
Ethiopia, $232 in Rwanda and $278 in Zambia. Nearly half the cost, on average,
was the price of drugs – which will increase slightly as countries begin to use
more effective and more expensive drugs now recommended by the World Health
Organisation. CHAI, however, is about to announce a deal with generic drug
companies, which will reduce tenofovir-based regimens, which are the "gold-standard"
in the USA and recommended by the World Health Organisation, to $125 from $409.
CHAI says this will save countries over $500 million between now and 2015.
Kate
Condliffe, executive vice-president for health programmes at CHAI, said finances
were thought to be a bottleneck to expanding the numbers of drugs in many
countries. "The perception that treatment costs are higher is casting a
cloud over conversations on how to accelerate treatments," she said.
"You
sit through conversations on treatment and prevention where there should be
incredible optimism, given the science, and yet there is concern about
feasibility and cost that lead to an incremental approach."
But while
there are not huge opportunities to save money on treatment in the clinics,
there is a disparity between the costs at health facilities and the costs at
government level. That was illustrated this week in the major UNAIDS report,
which referred to national costs in Zambia – around a third higher than costs
in the clinic.
Schwartländer
said that even if one assumed a cost of $300 a patient a year, the bill to put
20 million people on HIV treatment would be $6bn a year. "It is not
outrageous. It can really be handled," he said.
"Look
at the amount of money moving around in low-income countries. $6bn should not
shock us – it is not impossible. We need a different view from that of the
'treatment timebomb'."
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| An Aids treatment clinic in South Africa – a study says the average cost of treatment in Africa should be $200. Photograph: Stephane De Sakutin/ AFP/Getty Images |
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