The real price of cheap tests for people with advanced HIV

Abstract

Many adults in Ethiopia, the Democratic Republic of the Congo (DRC) and Guinea learn they have HIV only when the virus has already badly weakened their bodies. Tuberculosis (TB) and a fungal infection of the brain then kill many of them in their first months of care. The World Health Organization (WHO) recommends a small package of tests and medicines that finds and stops these infections early. From 2027 the Global Fund, which pays for much of this care, will give each country less money, and US support is fall-ing. Each country's health ministry and its Global Fund committee are now deciding what to protect. I used a computer model to ask whether the package is good value. Good value means it buys more healthy years of life than the same money usually buys in each country's health system, which I call the benchmark. The tests and medicines turned out to be cheap. The real cost comes after: every person the package keeps alive needs HIV treatment for years. So each country's answer turns on what a year of HIV care costs there, against its benchmark. My analysis covers every adult starting HIV treatment as an outpatient, not only the very sick; advice for patients in hospital rests on trials.

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