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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Scaling up antiretroviral therapy in South Africa: The impact of speed on survival
Journal of Infectious Diseases, Volume 197, No. 9, Year 2008
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Description
Background. Only 33% of eligible human immunodeficiency virus (HIV)-infected patients in South Africa receive antiretroviral therapy (ART). We sought to estimate the impact of alternative ART scale-up scenarios on patient outcomes from 2007-2012. Methods. Using a simulation model of HIV infection with South African data, we projected HIV-associated mortality with and without effective ART for an adult cohort in need of therapy (2007) and for adults who became eligible for treatment (2008-2012). We compared 5 scale-up scenarios: (1) zero growth, with a total of 100,000 new treatment slots; (2) constant growth, with 600,000; (3) moderate growth, with 2.1 million; (4) rapid growth, with 2.4 million); and (5) full capacity, with 3.2 million. Results. Our projections showed that by 2011, the rapid growth scenario fully met the South African need for ART; by 2012, the moderate scenario met 97% of the need, but the zero and constant growth scenarios met only 28% and 52% of the need, respectively. The latter scenarios resulted in 364,000 and 831,000 people alive and on ART in 2012. From 2007 to 2012, cumulative deaths in South Africa ranged from 2.5 million under the zero growth scenario to 1.2 million under the rapid growth scenario. Conclusions. Alternative ART scale-up scenarios in South Africa will lead to differences in the death rate that amount to more than 1.2 million deaths by 2012. More rapid scale-up remains critically important. © 2008 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Walensky, Rochelle P.
United States, Boston
Massachusetts General Hospital
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Weinstein, Milton C.
United States, Boston
Harvard T.h. Chan School of Public Health
Martinson, Neil Alexander
United States, Baltimore
Johns Hopkins University
South Africa, Johannesburg
University of the Witwatersrand
Losina, Elena
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
United States, Boston
School of Public Health
Fofana, Mariam O.
United States, Boston
Massachusetts General Hospital
Goldie, Sue J.
United States, Boston
Harvard T.h. Chan School of Public Health
Divi, Nomita
United States, Boston
Massachusetts General Hospital
Yazdanpanah, Yazdan
France, Lille
Service Universitaire Des Maladies Infectieuses et du Voyageur
France, Lille
Evaluation Des Technologies de Santé et Des Pratiques Médicales Metrics
France, Paris
Cnrs Centre National de la Recherche Scientifique
Wang, Bingxia
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard Medical School
Paltiel, A. David
United States, New Haven
Yale School of Medicine
Freedberg, Kenneth A.
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard Medical School
United States, Boston
Harvard T.h. Chan School of Public Health
United States, Boston
School of Public Health
Statistics
Citations: 79
Authors: 12
Affiliations: 12
Identifiers
Doi:
10.1086/587184
ISSN:
00221899
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
South Africa