Nine countries in sub-Saharan Africa account for over three quarters of Africa’s burden of HIV/AIDS. Now, a new modeling study suggests there is a significant shortfall in the funding these countries will need to control the disease in the years to come.

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The researchers estimate the price tag for long-term control of HIV/AIDS in the African countries that carry 70% of the disease burden ranges from $98-261 billion.

Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe account for 70% of the burden of HIV/AIDS in Africa.

In the BMJ Open journal, researchers at Harvard T.H. Chan School of Public Health in Boston, MA, estimate the funding that the nine sub-Sahara African countries will need to treat and prevent HIV in 2015-2050.

The team used a model to calculate the funding the countries will need to 2050 – based on four different scenarios – with data from a publicly available UNAIDS tool called Spectrum.

The model calculated a significant shortfall between financing obligations and future funding available, showing that none of the countries can meet future obligations.

First author Rifat Atun, professor of global health systems at Harvard University, says:

“The HIV epidemic is far from over. The magnitude of funding needed to sustain the HIV fight is very large and the consequences of complacency even larger.”

He and his colleagues estimate the price tag for providing long-term HIV/AIDS prevention and treatment in the nine sub-Sahara African countries ranges from $98 billion to maintain current coverage levels, to $261 billion if coverage is scaled up to include all HIV-positive individuals.

Under current arrangements, an individual becomes eligible for treatment if their CD4 cell count – a measure of immune function – falls below 500/mm3. The scenario of every HIV-infected person in treatment is a goal that UNAIDS say is attainable if all countries adopt their Fast-Track Strategy.

In their estimates, the team also factored in extra costs that health systems will incur over and above anti-retroviral (ART) treatments. These additional costs stem from illnesses arising from long-term immune suppression and chronic diseases due to aging that a population living longer with HIV will develop.

Prof. Atun and colleagues say “front-loading” investments are needed to secure higher levels of coverage required to ultimately reduce HIV spread. Such up-front investment will also reduce future funding obligations.

They note that new, innovative sources of finance must be sought to maintain and expand HIV treatment and prevention, as domestic financing – currently the main source of funding – will not be enough.

In the paper, the team cites examples of innovative financing, such as in 2002-2012, when over $6 billion was raised by schemes such as “the Airline Solidarity Levy, the Children’s Investment Fund Management, and the International Finance Facility for Immunization.”

Mechanisms for raising innovative financing could include: “social impact bonds, social development bonds, diaspora bonds, sovereign bonds securitized against future revenue streams from extractive industries, and consumption taxes on alcohol and tobacco,” they write.

And they note how the Advance Market Commitments (AMC) for pneumococcal vaccine from the Vaccine Alliance offers an example from another area of how innovative financing could bring together donor and domestic efforts to “front-load” HIV spending.

The authors write that, despite the passage of 35 years since the start of the HIV epidemic, the quality and quantity of data about the disease and its spread is still poor, and many uncertainties relating to costs, benefits and future technologies remain.

But, they urge, even among these uncertainties, their estimates show there is still a need for substantial, long-term financial commitments, which must be met if we are to keep up the fight against HIV.

Prof. Atun and colleagues conclude:

There is an ethical responsibility to continue financing for those receiving ART, and not abandon them to death.”

Meanwhile, Medical News Today recently learned about a study that found vaginal rings releasing a powerful anti-retroviral drug reduced the risk of HIV infection by 61% in women who used them consistently.