South African HIV Investment Case: 2023 Full Report

By  Dr. Lise Jamieson  Professor Gesine Meyer-Rath  Mmamapudi Kubjane  Leigh Johnson  |  | 


Key summary points:
  • All currently implemented interventions are affordable under the current budget (baseline
    scenario). Additionally, a few interventions scale up under the “constrained scenario” (a selection
    of the most cost-effective interventions that can be funded from the current budget)- condom
    provision (to 1.3 billion condoms/year) continues to be the only cost saving intervention, followed
    by HIV self-testing (HIVST) (to 500,000 tests/year), infant polymerase chain reaction (PCR) testing at 10 weeks (95% coverage), improving monthly linkage to antiretroviral treatment (ART) (to 81%). However, recent budget cuts render scaling up additional interventions unaffordable.
  • The constrained scenario will result in achieving 93% ART coverage from 2028, mostly due to improving ART linkage, and will have a substantial impact on the HIV epidemic. Scaling up the above-mentioned interventions under the constrained scenario is projected to avert 880,000 new HIV infections and 78,700 AIDS deaths over a 20-year period.
  • Scaling up medical male circumcision (MMC) further than its already high current coverage levels will not be affordable under the current budget if monthly ART linkage is also to be increased.
  • Equally, scaling up oral pre-exposure prophylaxis (PrEP) or injectable PrEP with long-acting cabotegravir (CAB-LA) will not be affordable under the current budget once all the interventions in the constrained scenario are scaled up, due in large parts to the current high cost of CAB-LA.
  • Additional sub-analyses (presented in the Supplementary Appendix) indicate that without the planned cuts to the HIV budget in 2024/25 and 2025/26, we could afford increasing ART coverage to 95%, as well as several HIV testing interventions, resulting in the attainment of the UNAIDS 95- 95-95 targets as well as a higher impact on the HIV epidemic.
  • Further, if we do not improve monthly ART linkage after testing and assume the current trajectory for ART coverage instead, we will not reach the second UNAIDS target by 2030, achieving at a maximum 85% and 62% ART coverage in adults and children, respectively.
  • Improving monthly ART linkage to 95% is the only way to achieve the second UNAIDS 95-95-95 target, i.e. 95% ART coverage.

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