Gray Richard T, Watson Jo, Cogle Aaron J, Smith Don E, Hoy Jennifer F, Bastian Lisa A, Finlayson Robert, Drummond Fraser M, Whittaker Bill, Law Matthew G, Petoumenos Kathy
The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.
National Association of People with HIV Australia (NAPWHA), Sydney, NSW 2042, Australia.
Sex Health. 2018 Feb;15(1):13-19. doi: 10.1071/SH16237.
Background The aim of this study is to estimate the reduction in new HIV infections and resultant cost outcomes of providing antiretroviral treatment (ART) through Australia's 'universal access' health scheme to all temporary residents with HIV infection living legally in Australia, but currently deemed ineligible to access subsidised ART via this scheme.
A mathematical model to estimate the number of new HIV infections averted and the associated lifetime costs over 5 years if all HIV-positive temporary residents in Australia had access to ART and subsidised medical care was developed. Input data came from a cohort of 180 HIV-positive temporary residents living in Australia who are receiving free ART donated by pharmaceutical companies for up to 4 years.
Expanding ART access to an estimated total 450 HIV+ temporary residents in Australia for 5 years could avert 80 new infections. The model estimated the total median discounted (5%) cost for ART and associated care to be A$36million, while the total savings in lifetime-discounted costs for the new infections averted was A$22million.
It is estimated that expanded access to ART for all HIV-positive temporary residents in Australia will substantially reduce HIV transmission to their sexual partners at little additional cost. In the context of Australia's National HIV strategy and Australia's endorsement of global goals to provide universal access to ART for all people with HIV, this is an important measure to remove inequities in the provision of HIV-related treatment and care.
背景 本研究旨在评估通过澳大利亚“全民可及”医疗计划，为所有合法居住在澳大利亚但目前被认定无资格通过该计划获得补贴抗逆转录病毒治疗（ART）的HIV感染临时居民提供ART后，新HIV感染的减少情况以及由此产生的成本效益。
建立了一个数学模型，以估计如果澳大利亚所有HIV阳性临时居民都能获得ART和补贴医疗服务，5年内可避免的新HIV感染数量及相关终身成本。输入数据来自一组180名居住在澳大利亚的HIV阳性临时居民，他们接受制药公司捐赠的免费ART长达4年。
在5年内将ART的可及范围扩大到澳大利亚估计共450名HIV+临时居民，可避免80例新感染。该模型估计，ART及相关护理的总中位数贴现（5%）成本为3600万澳元，而避免新感染所节省的终身贴现成本总额为2200万澳元。
据估计，扩大澳大利亚所有HIV阳性临时居民获得ART的机会，将以很少的额外成本大幅减少HIV向其性伴侣的传播。在澳大利亚国家HIV战略以及澳大利亚认可为所有HIV感染者提供普遍ART全球目标的背景下，这是消除HIV相关治疗和护理提供方面不平等的一项重要措施。
