Cost-benefit analysis of TasP compared with circumcision, ART

Published on December 8, 2012 at 12:32 AM · 2 Comments

In a study published online in the Proceedings of the National Academy of Sciences, Till Barnighausen, David Bloom, and Salal Humair of the Harvard School of Public Health examine "whether [HIV treatment as prevention (TasP)] is indeed a game changer or if comparable benefits are obtainable at similar or lower cost by increasing coverage of medical male circumcision (MMC) and antiretroviral treatment (ART)." They write, "The most cost-effective HIV prevention strategy is to expand MMC coverage and then scale up ART, but the most cost-effective HIV-mortality reduction strategy is to scale up MMC and ART jointly. TasP is cost effective by commonly used absolute benchmarks but it is far less cost effective than MMC and ART" (12/6).


http://www.kaiserhealthnews.orgThis article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

 

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Comments
  1. Mark Lyndon Mark Lyndon United Kingdom says:

    From a USAID report:
    "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."
    http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

    It seems highly unrealistic to expect that there will be no risk compensation.  The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".
    http://www.info.gov.za/issues/hiv/survey_2009.htm

    It is unclear if circumcised men are more likely to infect women.  The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:
    www.thelancet.com/.../abstract

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward.  Promoting genital surgery seems likely to cost African lives rather than save them.

  2. Ron Low Ron Low United States says:

    It's quite offensive to even discuss the costs and benefits of treating a whole normal patient vs cutting body parts off.  

    Lacking body parts is not health.  Amputation is a last resort not preventive medicine.

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