Book launch, Delhi13 Aug 04.PPT

Integrating HIV prevention and antiretroviral therapy in India: Costs and Consequences of Policy Options Report team: Mead Over, Peter Heywood, Sudhakar Kurapati (World Bank) Julian Gold, Indrani Gupta, Abhaya Indrayan, Subhash Hira, Elliot Marseille, Nico Nagelkerke, and Arni S.R. Srinivasa Rao (Consultants) Objectives of the study Review the effects and consequences of ART Use a quantitative model to predict the course of the epidemic Use same model to determine the costs and consequences of Maintaining current policies Alternative government policies for ART Indian context for ART policy HIV Prevalence 1998 Indian context for ART policy HIV/AIDS in context of overall disease burden in 1998: 2% of all deaths, 6% of inf. deaths in 2033: 17% of all deaths, 40% of inf. Deaths Number of ART users in 2002 500,000 AIDS cases 370,000 urban 90,000 on treatment 12,000 on ART – mostly unstructured Analysis of ART policy options Definition of policy options Health impacts of options Cost impact of options Sensitivity of results to risk behavior Cost-effectiveness Definition of policy options Adhere: Support to help patients adhere I.e. IEC, training, lab strengthening, subsidies for patient monitoring in both private public sectors MTCT+: Structured ART for identified HIV+ mothers and their partners BPL: Structured ART for people below the poverty line TMART: Transmission-minimizing ART Structured treatment Standardized training of physician to a mandated level of competence in ART management; Prescription of a standard triple-drug regimen as recommended by the national guidelines; Access to support from a multi-disciplinary team including a counselor and a nutritionist; Access to a quality laboratory for immunological testing; Regular monitoring of the patient’s treatment status (clinical and lab-based). Counseling to prevent transmission ART can affect HIV prevention Suggestive evidence of disinhibition in Kenya Transmission minimizing structure Structured ART tr