HIV/AIDS treatment and prevention in India: modeling the cost and consequences

The report from the World Bank analyses three alternative plans for using and financing antiretroviral therapy (ART) in India: a minimally interventionist plan to strengthen the private sector’s ability to manage ART; a moderately interventionist plan to provide free ART to HIV-positive pregnant women; and a more generous plan to finance ART for the poorest 40 percent of all Indians with HIV infection. The report recommends that Indian government take advantage of its pharmaceutical and public health expertise and proffered assistance from international agencies to extend ART. But the authors sound several notes of caution.

First, the report finds that cost-effectiveness results will only be attainable if patients also receive high quality medical care. Second, the study assumes that patients will enter treatment relatively early. This will require a greatly expanded effort to reduce the social stigma associated with a positive HIV diagnosis and to attract people into voluntary counseling and testing centers. Third, the study shows that AIDS treatment alone will not materially slow the spread of HIV infection. Indeed, unless prevention efforts are greatly strengthened, the commitment to universal access will become increasingly expensive. Fourth, the results depend upon condom use on high-risk sexual contacts being sustained despite the existence of freely accessible AIDS treatment. [adapted from author]