Epidemic to Endemic: The Economic Impact of HIV/AIDS

Transcription

1 Understanding the Economics of Microbial Threats Epidemic to Endemic: The Economic Impact of HIV/AIDS Katharina Hauck Forum on Microbial Threats Workshop on Understanding the Economics of Microbial Threats The National Academies of Sciences, Engineering, Medicine Washington (D.C.), June 2018

2 Epidemic to Endemic: The Economic Impact of HIV/AIDS The link between HIV and GDP Higher dependency ratio Labour force reduced by premature mortality and retirement Orphan hood Lower GDP per capita Reduced consumption Reduced labour productivity HIV infection Reduced investment in education Reduced savings & investments Adapted from: Prah J, Jamison DT, Bloom DE, Health and the Economy, in International Public Health, 2001

3 Days Epidemic to Endemic: The Economic Impact of HIV/AIDS 2.5 Productive days lost over past 3 months by HIV status and labour force status, HPTN071 (PopART) study baseline, 17,397 individuals from 9 communities in Zambia HIV- all HIV- ILF HIV- NILF HIV+ all HIV+ ILF HIV+ NILF Thomas et al. Work and home productivity of HIV-positive and HIV-negative individuals in Zambia and South Africa: cross-sectional baseline survey of the HPTN 071 (PopART) trial Under peer review.

4 Tea leaves plucked per day (in kg) Epidemic to Endemic: The Economic Impact of HIV/AIDS Decline in work output before termination of work due to AIDS, 54 HIV-positive workers at a tea plantation in Kenya HIV-positive HIV-negative Months before termination of work Source: Fox M.P. et al. The impact of HIV/AIDS on labour productivity in Kenya. Tropical Medicine and International Health Volume 9 no 3 pp

5 Days working (per month) Epidemic to Endemic: The Economic Impact of HIV/AIDS Work days lost before and after starting Anti-retroviral therapy, 237 HIV-positive workers at two tea plantations in Kenya HIV-positive HIV-negative Duration on Anti-retroviral therapy (months) Source: Larson B.A. et al. Antiretroviral therapy, labour productivity, and gender: a longitudinal cohort study of tea pluckers in Kenya. AIDS. 2013; 27(1):

6 HRQoL Epidemic to Endemic: The Economic Impact of HIV/AIDS Health-related Quality-of-Life, HIV-negative and HIV-positive at different stages of treatment, HPTN 071 (PopART) study baseline, 19,637 individuals from 9 communities in Zambia % on ART Thomas R et al. Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa: a cross-sectional baseline survey of the HPTN 071 (PopART) trial. Lancet Global Health. The Lancet Global Health, 2017, 5(11), pp.e1133-e1141

7 Epidemic to Endemic: The Economic Impact of HIV/AIDS Policy conclusions (from an economist) Extraordinary success of ART improving HRQoL and work productivity Problem areas: Late linkage to care and initiation on treatment Transmissions by PLWHs unaware of status may drive epidemics Unawareness at 44% in Zambia, and 51% in South Africa Strong rationale for testing and prevention policies Governments need to intervene because of high positive externalities But what do PLWH say? we bear the costs of preventing infections but have no direct benefits

8 Epidemic to Endemic: The Economic Impact of HIV/AIDS Policy conclusions (from an economist) HIV policies build on assumption that PLWH are altruistic Altruism contradicts the economic theory of rational behaviour Individuals consider only their own benefits and costs when demanding prevention, not benefits and costs to others Empirical evidence on change in risky sexual behaviour after testing HIV-positive is inconclusive Is Universal-test-and-treat a way out? Prevention benefit to sexual partner Treatment benefit to PLWH But treatment benefit questionable because little HRQoL improvements in early stages of infection

9 Epidemic to Endemic: The Economic Impact of HIV/AIDS Policy conclusions (from an economist) Acknowledge that we may have systemic problems with early linkage to care Arising from the fact that PLWH in early stage may have little incentive to go on treatment Don t forget our efforts on testing on prevention policies targeted at both HIV-negative and PLWH on adherence counselling Thank you!

10 ACKNOWLEDGEMENTS Sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) under Cooperative Agreements # UM1 AI068619, UM1-AI068617, and UM1-AI Funded by: The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) The International Initiative for Impact Evaluation (3ie) with support from the Bill & Melinda Gates Foundation NIAID, the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) all part of the U.S. National Institutes of Health (NIH)

11 Epidemic to Endemic: The Economic Impact of HIV/AIDS HPTN071 (PopART) study Landmark study in Zambia and South Africa Impact of a combination prevention package on HIV incidence on population level Secondary outcomes related to behavior, economics, stigma and others Target population over 400,000 Results expected next year

12 The HPTN 071 Study Team, led by: Dr. Richard Hayes Dr. Sarah Fidler Dr. Helen Ayles Dr. Nulda Beyers Dr. Peter Bock Government Agencies: PEPFAR Implementing Partners:

13 Prevalence of HIV, total (% of population ages 15-49) Epidemic to Endemic: The Economic Impact of HIV/AIDS 30 Prevalence of HIV and GDP per capita, 129 countries, ,000 20,000 30,000 40,000 50,000 60,000 70,000 GDP per capita (2016 US$) Source: World Development Indicators 2017, The World Bank

14 Epidemic to Endemic: The Economic Impact of HIV/AIDS Studies of economic impact on individual level Treatment efficacy Household income in t 1 Risk of infection HIV-infection in t 2 Household income in t 3 Different? Different? Different? Household income in t 1 Risk of infection No HIVinfection in t 2 Household income in t 3