A new report on Thailand's experience of giving free anti-retroviral drugs (ART) to people living with AIDS suggests that even developing countries with few resources may be able to deliver the life-saving drugs on a large scale, according to the World Bank and the Thailand Ministry of Public Health.
Of the estimated 40 million people worldwide infected with HIV, UNAIDS says between 5 to 6 million could immediately benefit from ART; but currently only 700,000 people are being treated with the new therapy. In contrast, by May, 2006 Thailand was providing treatment for approximately 78 thousand AIDS patients, more than 90 percent of those in need of treatment.
The new report "The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand" says that the country's ability to provide ART affordably to more than 80,000 Thais with AIDS is the result of highly effective prevention campaigns over previous years, a vast network of district level hospitals and rural health clinics with the capacity to provide widespread treatment, a strong NGO community that has worked closely with government on rolling out the expanded ART program, and the close involvement of people living with HIV/AIDS themselves.
"Thailand's ART program is a useful beacon for other developing countries which are looking at how to provide this treatment to people with advanced HIV," says Ana Revenga, co-author of the new report and a World Bank Lead Economist in its East Asia and the Pacific department. "We conclude that Thailand can afford universal treatment, and is rightly in the vanguard of developing countries seeking to provide antiretroviral therapy as the standard of care to large numbers of people with symptomatic HIV disease."
Providing ART in Thailand
Since the first case of AIDS in Thailand was reported in September 1984, more than 1 million Thais have been infected with HIV, and, of those, more than 400,000 have died. In 2004, an estimated 572,500 Thais were living with HIV/AIDS. Among those people, some 49,500 developed serious AIDS-related illnesses during the year, and about the same number died of AIDS-related complications. It is also estimated that 19,500 new infections occurred in 2004.
Thailand has shown strong commitment to providing comprehensive care and support to people living with HIV/AIDS, but it is only recently that it has been able to provide ART to large numbers of people with symptomatic HIV, thanks to a affordable domestically- produced triple-drug combination, called GPO-vir (stavudine + lamivudine + nevirapine), which costs about US$30 per month. This has allowed the Ministry of Public Health (MOPH) to roll out a large-scale campaign to provide triple-drug ART as standard care.
The report says that in a few years, as AIDS patients live longer with ART, the Thai health system will need to provide care not only to 10,000 to 20,000 new cases per year, but also to most of those whose lives have been significantly prolonged by ART. Thailand has good prospects for meeting this challenge. Its ability to even contemplate providing care to all those who need it, however, rests on the success of its past prevention efforts.
The World Bank authors estimate that without such effective prevention campaigns over previous years, Thailand would have had 7.7 million HIV cases and 850,000 AIDS cases in 2005, roughly 14 times more than it has today. Treating this much larger group with ART would have been vastly more expensive, and that burden would have continued to grow over the next decade. Because of its substantial prevention efforts between 1991 and 2002, Thailand has avoided the need to spend an additional US$18.6 billion on treatment over the decade through 2012.
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We estimate that in the absence of the Thais' extraordinarily effective HIV prevention program, the cost of universal access to treatment would be roughly ten times larger than currently and by 2013, would exceed 330 percent of their entire projected health budget," says
Mead Over, a co-author, and a World Bank Health Lead Economist. "Thailand's past success with prevention is the most important reason the country can afford universal access to ART today. Furthermore it is an essential condition of its continued ability to afford treatment in the future."
Over says Thailand may have saved $43 in treatment cost for every dollar it spent on prevention and it is doubtful that any other Thai government investment has ever achieved such a high benefit-cost ratio. The finance ministries of countries such as China and India, where the HIV/AIDS epidemic is at an earlier stage, should be aware of the high return to HIV/AIDS prevention campaigns when they make allocations of their governments' budgets.
No room for complacency