Nattrass Nicoli, Geffen Nathan
Afr J AIDS Res. 2005 May;4(1):65-7. doi: 10.2989/16085900509490343.
South Africa has started 'rolling out' highly active anti-retroviral therapy (HAART) through the public health sector, but implementation has been slow. Studies have shown that in Africa AIDS prevention may be more cost-effective than providing HAART; such published results provide some support for the South African government's apparent reluctance to implement a large-scale rapid HAART roll-out. However, previous studies have not linked treatment and prevention plans, and do not, for the most part, consider the potential savings to the public health sector (e.g., fewer hospital admissions) that may arise from the introduction of HAART. The South African costing exercise summarised here avoids both these limitations. It provides an update of earlier work and takes into account the recent decline in antiretroviral drug prices. It shows that once HIV-related hospital costs are included in the calculation, the cost per HIV infection averted is lower in a treatment-plus-prevention intervention scenario than it is in a prevention-only scenario. This suggests that it is economically advantageous to fund a large-scale comprehensive intervention plan and that the constraints for doing so are political. Once human-rights considerations are included, the case for providing HAART is even more compelling.
南非已开始通过公共卫生部门“推广”高效抗逆转录病毒疗法（HAART），但实施进展缓慢。研究表明，在非洲，预防艾滋病可能比提供HAART更具成本效益；这些已发表的结果为南非政府明显不愿大规模快速推广HAART提供了一些支持。然而，以往的研究并未将治疗和预防计划联系起来，而且在很大程度上没有考虑到引入HAART可能给公共卫生部门带来的潜在节省（例如，减少住院人数）。此处总结的南非成本核算工作避免了这两个局限性。它提供了早期工作的最新情况，并考虑到了近期抗逆转录病毒药物价格的下降。结果表明，一旦将与艾滋病相关的住院费用纳入计算，在治疗加预防干预方案中，避免每例艾滋病感染的成本低于仅采取预防措施的方案。这表明，为大规模综合干预计划提供资金在经济上是有利的，而这样做的制约因素是政治性的。一旦将人权因素考虑在内，提供HAART的理由就更有说服力了。
