Budget cuts place HIV prevention shot even further out of reach

The Treasury’s recent cuts to HIV/Aids budget have placed costly new HIV prevention drugs such as the long-acting cabotegravir (Cab-LA) even further out of reach for SA, with only condoms providing a cost-saving return on investment, according to Wits University researchers.

SA can still afford to expand HIV self-testing, improve systems to encourage people to start or resume treatment and test young babies, but increasing medical male circumcision and providing pills or shots to prevent HIV are unaffordable within the current budget constraints, according to the latest HIV investment case report from the Wits Health Economics and Epidemiology Research Office (HE²RO). 

The analysis raises questions about prices at which pharmaceutical companies are offering their drugs to SA, and puts pressure on the health department to step up its efforts to raise awareness about condoms and ensure they are readily accessible to people who want to use them.

ViiV Healthcare recently offered to drop the price of Cab-LA from £32 to £24 per shot but even this price is unaffordable for SA, according to the investment case. The shot, taken every two months, virtually eliminates the risk of contracting HIV from sex. Providing Cab-LA at £24 per shot to priority groups such as sex workers and pregnant women would cost SA between R8.7bn and R11.4bn per year, pushing the total HIV/Aids budget up by more than a third.

“It is really a pity to have a price that renders a highly effective intervention less cost effective than those you already have,” said Gesine Meyer-Rath, associate professor at Boston University School of Public Health and a HE²RO researcher.

Condom use in SA has declined steadily over the past decade, according to the latest household survey from the Human Sciences Research Council (HSRC) and the government no longer distributes millions of free condoms to venues outside health facilities. In 2008, 66.5% of young women and 85.2% of young men said they had used condoms the last time they had sex; by 2021 the figures had dropped to 43.5% among women and 50.6% among men.

Meyer-Rath said the HSRC data was concerning, as condoms were cheap and effective. 

The HE²RO 2023 HIV investment case is the latest in a series published since 2016, and sets out the optimal mix of interventions within the government’s spending constraints. SA has the world’s biggest HIV burden, with 7.8-million people living with the disease and an estimated 5.8-million people on treatment.

The government provides the lion’s share (76%) of SA’s total HIV/Aids spending, with the balance coming from the US President’s Emergency Plan for Aids Relief and the Global Fund. As donor funding has stagnated in recent years, any changes made by the Treasury — such as the R1bn cut it made to the HIV/Aids conditional grant for the second half of the current fiscal year in the medium-term budget policy statement — have a profound impact.

It sets out four priority interventions that could help SA get close to the UN’s 95-95-95 targets and reach an HIV incidence of 0.1%, (virtually eliminating the disease) by 2032. The 95-95-95 targets aim to ensure that by 2025, 95% of people with HIV know their status, 95% of the people diagnosed with HIV get antiretroviral treatment and 95% of those being treated achieve viral suppression, reducing the risk of transmitting the virus.

The four priorities are: scaling up condom provision, increasing HIV self-testing and infant PCR testing at 10 weeks and improving “linkage to care” to increase the proportion of people diagnosed with HIV who are on treatment.

“This list sets out the best bang for our buck,” said HE²RO researcher Lise Jamieson.

However, even these limited interventions would require a 7% increase to the baseline, which is expected to range of R24.7bn to R26bn over the next 20 years. Increasingly, linkage to care was the main cost driver in this scenario.

kahnt@businesslive.co.za