Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive
Richard T. Gray A I , Jo Watson B , Aaron J. Cogle B , Don E. Smith C D , Jennifer F. Hoy E , Lisa A. Bastian F , Robert Finlayson G , Fraser M. Drummond H , Bill Whittaker B , Matthew G. Law A and Kathy Petoumenos A
+ Author Affiliations
- Author Affiliations
A The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.
B National Association of People with HIV Australia (NAPWHA), Sydney, NSW 2042, Australia.
C Albion Centre, Sydney, NSW 2010, Australia.
D School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW 2052, Australia.
E Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne Vic. 3181, Australia.
F Western Australian Department of Health, Perth, WA 6004, Australia.
G Taylor Square Private Clinic, Taylor Square, Sydney, NSW 2010, Australia.
H ViiV Healthcare, Abbotsford, VIC 3067, Australia.
I Corresponding author. Email: Rgray@kirby.unsw.edu.au
Sexual Health 15(1) 13-19 https://doi.org/10.1071/SH16237
Submitted: 19 December 2016 Accepted: 14 June 2017 Published: 6 September 2017
Abstract
Background: The aim of this study is to estimate the reduction in new HIV infections and resultant cost outcomes of providing antiretroviral treatment (ART) through Australia’s ‘universal access’ health scheme to all temporary residents with HIV infection living legally in Australia, but currently deemed ineligible to access subsidised ART via this scheme. Methods: A mathematical model to estimate the number of new HIV infections averted and the associated lifetime costs over 5 years if all HIV-positive temporary residents in Australia had access to ART and subsidised medical care was developed. Input data came from a cohort of 180 HIV-positive temporary residents living in Australia who are receiving free ART donated by pharmaceutical companies for up to 4 years. Results: Expanding ART access to an estimated total 450 HIV+ temporary residents in Australia for 5 years could avert 80 new infections. The model estimated the total median discounted (5%) cost for ART and associated care to be A$36 million, while the total savings in lifetime-discounted costs for the new infections averted was A$22 million. Conclusions: It is estimated that expanded access to ART for all HIV-positive temporary residents in Australia will substantially reduce HIV transmission to their sexual partners at little additional cost. In the context of Australia’s National HIV strategy and Australia’s endorsement of global goals to provide universal access to ART for all people with HIV, this is an important measure to remove inequities in the provision of HIV-related treatment and care.
Additional keywords: antiretroviral therapy, Australia, HIV prevention, mathematical modelling, migrants, treatment access.
References
[1] Bor J, Herbst AJ, Newell M-L, Barnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science 2013; 339 961–5.| Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXis1Oisbg%3D&md5=5e99e47419f1cd2a01472589fc1f14b3CAS |
[2] Brinkhof MWG, Boulle A, Weigel R, Messou E, Mathers C, Orrell C, Dabis F, Pascoe M, Egger M, International Epidemiological Databases to Evaluate AIDS (IeDEA) Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality. PLoS Med 2009; 6 e1000066
| Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality.Crossref | GoogleScholarGoogle Scholar |
[3] Egger M, May M, Ge C, Phillips AN, Ledergerber B, Dabis F, Costagliola D, D’Arminio Monforte A, de Wolf F, Reiss P, Lundgren JD, Justice AC, Staszewski S, Leport C, Hogg RS, Sabin CA, Gill MJ, Salzberger B, Sterne JA, ART Cohort Collaboration Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002; 360 119–29.
| Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies.Crossref | GoogleScholarGoogle Scholar |
[4] May M, Boulle A, Phiri S, Messou E, Myer L, Wood R, Keiser O, Sterne JA, Dabis F, Egger M. IeDEA Southern Africa and West Africa. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet 2010; 376 449–57.
| IeDEA Southern Africa and West Africa. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes.Crossref | GoogleScholarGoogle Scholar |
[5] Yiannoutsos CT, Johnson LF, Boulle A, Musick BS, Gsponer T, Balestre E, Law M, Shepherd BE, Egger M, International Epidemiologic Databases to Evaluate AIDS (IeDEA) . Collaboration. Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy. Sex Transm Infect 2012; 88 i33–43.
| Collaboration. Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[6] Attia S, Egger M, Müller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS 2009; 23 1397–404.
| Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[7] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim . Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim . Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365 493–505.
| Prevention of HIV-1 infection with early antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXhtVars7jF&md5=9d5b438e848fffcec39bc07afd963760CAS |
[8] Donnell D, Baeten JM, Kiarie J, Thomas KK, Stevens W, Cohen CR, McIntyre J, Lingappa JR, Celum C, Partners in Prevention HSV/HIV Transmission Study Team Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet 2010; 375 2092–8.
| Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis.Crossref | GoogleScholarGoogle Scholar |
[9] Eaton JW, Johnson LF, Salomon JA, Bärnighausen T, Bendavid E, Bershteyn A, Bloom DE, Cambiano V, Fraser C, Hontelez JA, Humair S, Klein DJ, Long EF, Phillips AN, Pretorius C, Stover J, Wenger EA, Williams BG, Hallett TB. HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa. PLoS Med 2012; 9 e1001245
| HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa.Crossref | GoogleScholarGoogle Scholar |
[10] World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. World Health Organization, Geneva Switzerland 2015.
[11] Australian Government, Department of Health and Aging. The Pharmaceutical Benefits Scheme: Section 100 – Highly Specialised Drugs Program. Available online at: http://www.pbs.gov.au/info/browse/section-100/s100-highly-specialised-drugs [verified 14 July 2017].
[12] Schneider K, Gray RT, Wilson DP. A cost-effectiveness analysis of HIV pre-exposure prophylaxis for men who have sex with men in Australia. Clin Infect Dis 2014; 58 1027–34.
| A cost-effectiveness analysis of HIV pre-exposure prophylaxis for men who have sex with men in Australia.Crossref | GoogleScholarGoogle Scholar |
[13] Herrmann S, Wardrop J, John M, Gaudieri S, Lucas M, Mallal S, Nolan D. The impact of visa status and Medicare eligibility on people diagnosed with HIV in Western Australia: a qualitative report. Sex Health 2012; 9 407–13.
| The impact of visa status and Medicare eligibility on people diagnosed with HIV in Western Australia: a qualitative report.Crossref | GoogleScholarGoogle Scholar |
[14] Petoumenos K, Watson J, Whittaker B, Hoy J, Smith D, Bastian L, Finlayson R, Sloane A, Wright ST, McManus H, Law MG. Subsidized optimal ART for HIV-positive temporary residents of Australia improves virological outcomes: results from the Australian HIV Observational Database Temporary Residents Access Study. J Int AIDS Soc 2015; 18 19392
| Subsidized optimal ART for HIV-positive temporary residents of Australia improves virological outcomes: results from the Australian HIV Observational Database Temporary Residents Access Study.Crossref | GoogleScholarGoogle Scholar |
[15] The Kirby Institute. The Australian HIV Observational Database Temporary Residents Access Study (ATRAS) One year follow-up. Sydney, NSW: The Kirby Institute, UNSW Australia; 2013.
[16] Jansson J, Kerr CC, Mallitt K-A, Wu J, Gray RT, Wilson DP. Inferring HIV incidence from case surveillance with CD4+ cell counts. AIDS 2015; 29 1517–25.
| Inferring HIV incidence from case surveillance with CD4+ cell counts.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2MXhsVOntrzL&md5=10e2a972efee92e3642cb9145fb74670CAS |
[17] The Kirby Institute. HIV in Australia Annual Surveillance Report. Supplement. Sydney, NSW: The Kirby Institute, UNSW Australia; 2014.
[18] Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, Corbelli GM, Estrada V, Geretti AM, Beloukas A, Asboe D, Viciana P, Gutiérrez F, Clotet B, Pradier C, Gerstoft J, Weber R, Westling K, Wandeler G, Prins JM, Rieger A, Stoeckle M, Kümmerle T, Bini T, Ammassari A, Gilson R, Krznaric I, Ristola M, Zangerle R, Handberg P, Antela A, Allan A, Phillips AN, Lundgren J. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 2016; 316 171–81.
| Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[19] Jansson J, Wilson DP, Carr A, Petoumenos K, Boyd MA. Currently available medications in resource-rich settings may not be sufficient for lifelong treatment of HIV. AIDS 2013; 27 1245–51.
| Currently available medications in resource-rich settings may not be sufficient for lifelong treatment of HIV.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXpsFaiurc%3D&md5=1d3815b8db432b0f1174d8de535c22daCAS |
[20] Gray RT. ART_For_Temporary_Residents: version corresponding to accepted paper [Data set]. Geneva: Zenodo; 2017. Available online at: https://zenodo.org/record/825366#.WX65LoSGPRY
[21] R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; 2016. Available online at: https://www.R-project.org/ [verified 14 July 2017]
[22] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report. Sydney, NSW: The Kirby Institute, UNSW Australia; 2015
[23] Department of Health and Human Services. Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available online at: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf [verified 4 April 2016].
[24] INSIGHT START Study Group Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, Avihingsanon A, Cooper DA, Fätkenheuer G, Llibre JM, Molina JM, Munderi P, Schechter M, Wood R, Klingman KL, Collins S, Lane HC, Phillips AN, Neaton JD. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 2015; 2015 795–807.
[25] Australia Government, Department of Health. Seventh National HIV Strategy 2014–2017. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-hiv [verified 7 July 2017].
[26] Lemoh C, Guy R, Yohannes K, Lewis J, Street A, Biggs B, Hellard M. Delayed diagnosis of HIV infection in Victoria 1994 to 2006. Sex Health 2009; 6 117–22.
| Delayed diagnosis of HIV infection in Victoria 1994 to 2006.Crossref | GoogleScholarGoogle Scholar |
[27] Lemoh CN, Baho S, Grierson J, Hellard M, Street A, Biggs B-A. African Australians living with HIV: a case series from Victoria. Sex Health 2010; 7 142–8.
| African Australians living with HIV: a case series from Victoria.Crossref | GoogleScholarGoogle Scholar |
[28] McMahon T, Moreton RJ, Luisi BN. Guarding against emerging epidemics: addressing HIV and AIDS among culturally and linguistically diverse communities in NSW. NSW Public Health Bull 2010; 21 83–5.
| Guarding against emerging epidemics: addressing HIV and AIDS among culturally and linguistically diverse communities in NSW.Crossref | GoogleScholarGoogle Scholar |
