Getting to Zero HIV (and addressing other sexually transmitted infection epidemics)
Where did Getting to Zero HIV come from?
WHO / UNAIDS campaign since 2011 when it was beginning to be understood that effective treatment was a key tool for prevention
The latest UNAIDS 90:90:90 campaign aims to diagnose 90% of people with HIV, engage 90% into care to start HIV treatment and that 90% of patients become undetectable (i.e. uninfectious). In a few countries this target has already been reached; however, find the remaining undiagnosed HIV positive individuals is an ongoing challenge
To achieve the first "90" - we need targeted testing and effective partner services to reduce the cost to make a diagnosis and ensure that we can get to zero HIV by 2030 with an emphasis on 'Fast-track cities'; however, each city has a limit to the resources that they can spend on this problem
When trying to work out the cost to diagnose a case of HIV a back of the envelope calculation is a useful exercise but it should be taken with a pinch of salt
The table below uses the following sources & assumptions:
Where did Getting to Zero HIV come from?
WHO / UNAIDS campaign since 2011 when it was beginning to be understood that effective treatment was a key tool for prevention
The latest UNAIDS 90:90:90 campaign aims to diagnose 90% of people with HIV, engage 90% into care to start HIV treatment and that 90% of patients become undetectable (i.e. uninfectious). In a few countries this target has already been reached; however, find the remaining undiagnosed HIV positive individuals is an ongoing challenge
To achieve the first "90" - we need targeted testing and effective partner services to reduce the cost to make a diagnosis and ensure that we can get to zero HIV by 2030 with an emphasis on 'Fast-track cities'; however, each city has a limit to the resources that they can spend on this problem
When trying to work out the cost to diagnose a case of HIV a back of the envelope calculation is a useful exercise but it should be taken with a pinch of salt
The table below uses the following sources & assumptions:
- The background incidence rate is key to doing these calculations from low incidence countries where it is 9/100,000 (England, PHE) & 12/100,000 (CDC Atlas, Massachusetts) to some sub-Saharan countries where it is 100x times higher e.g. Eswatini 862/100,000 (UNAIDS HIV estimates)
- The background rate will affect all the following estimates so I have focused on a country with low incidence
- Testing in sexual health clinics has a 3/1000 diagnostic rate (18 months data from inner London clinic)
- Outreach testing has three times the yield of 10/1000 (based on conversation with NAZ Latina)
- The BASHH / BHIVA audit in 2018 on HIV partner services found that 18% of partners were infected whilst in countries where less patients are undetectable this number has been as high as 35% (20% was chosen as a representative figure)
Testing strategy
|
HIV diagnostic rate (#/1000)
|
Diagnostic cost to diagnose one
case of HIV ($20/test)
|
Difference
|
Screening blood donors
|
0.012
|
$166,666
|
Baseline
|
Targeted testing in specific venues
|
3
|
$6,667
|
x 25 less
|
Outreach & testing in ‘at risk’
communities
|
10
|
$2,000
|
x 83 less
|
Testing sex partners of patient
diagnosed with HIV
|
200
|
$100
|
x
1666 less
|
Step 2 - Notify Partners Away from the Clinic
Step 3 - Partners Receive Notification
Step 4 - Partners at the Clinic
