Article Synopsis
- The future of U.S. congressional funding for PEPFAR, which is crucial for HIV management in South Africa, is uncertain, particularly with a potential $460 million cut from the program in 2024.
- A model-based analysis predicts that if PEPFAR funding decreases to 50% or eliminates entirely, it could result in an additional 286,000 to 565,000 new HIV infections over ten years, significantly impacting life expectancy and healthcare costs.
- Sensitivity analyses suggest that countries heavily dependent on PEPFAR funding might face disproportionately higher rates of new infections and reduced survival due to funding cuts.
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Article Abstract
Background: Future U.S. congressional funding for the President's Emergency Plan for AIDS Relief (PEPFAR) program is uncertain.
Objective: To evaluate the clinical and economic impacts of abruptly scaling back PEPFAR funding ($460 million) from South Africa's total HIV budget ($2.56 billion) in 2024.
Design: Model-based analysis of 100%, 50%, and 0% PEPFAR funding with proportional decreases in HIV diagnosis rates (26.0, 24.3, 22.6 per 100 person-years [PY]), 1-year treatment engagement (people with HIV [PWH] receiving/initiating antiretroviral therapy: 92.2%/80.4%, 87.1%/76.0%, 82.0%/71.5%), and primary prevention (4.0%, 2.2%, 0.5% reduction in incidence with no programming [1.24 per 100 PY]).
Data Sources: Published HIV care continuum; PEPFAR funding estimates.
Target Population: South African adults (HIV prevalence, 16.2%; incidence, 0.32 per 100 PY).
Time Horizon: Lifetime.
Perspective: Health care sector.
Intervention: PEPFAR funded 100% (PEPFAR_100%), 50% (PEPFAR_50%), or 0% (PEPFAR_0%).
Outcome Measures: HIV infections, life expectancy, and lifetime costs (2023 U.S. dollars).
Results Of Base-case Analysis: With current HIV programming (PEPFAR_100%), 1 190 000 new infections are projected over 10 years; life expectancy would be 61.42 years for PWH, with lifetime costs of $11 180 per PWH. Reduced PEPFAR funding (PEPFAR_50% and PEPFAR_0%) would add 286 000 and 565 000 new infections, respectively. PWH would lose 2.02 and 3.71 life-years with nominal lifetime cost reductions of $620 per PWH and $1140 per PWH that would be offset at the population level by more PWH requiring treatment for infection.
Results Of Sensitivity Analysis: Countries with similar HIV prevalence and greater reliance on PEPFAR funding could experience disproportionately higher incremental infections and survival losses.
Limitation: Budget fungibility and exact programmatic implications of reducing PEPFAR funding are unknown.
Conclusion: Abrupt PEPFAR cutbacks would have immediate and long-term detrimental effects on epidemiologic and clinical HIV outcomes in South Africa.
Primary Funding Source: National Institutes of Health.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996594 | PMC |
| http://dx.doi.org/10.7326/ANNALS-24-01104 | DOI Listing |