title: Human Resources for Treating HIV/AIDS: Are the Preventive Effects of Antiretroviral Treatment a Game Changer?
abstract: Shortages of human resources for treating HIV/AIDS (HRHA) are a fundamental barrier to reaching universal antiretroviral treatment (ART) coverage in developing countries. Previous studies suggest that recruiting HRHA to attain universal ART coverage poses an insurmountable challenge as ART significantly increases survival among HIV-infected individuals. While new evidence about ART's prevention benefits suggests fewer infections may mitigate the challenge, new policies such as treatment-as-prevention (TasP) will exacerbate it. We develop a mathematical model to analytically study the net effects of these countervailing factors. Using South Africa as a case study, we find that contrary to previous results, universal ART coverage is achievable even with current HRHA numbers. However, larger health gains are possible through a surge-capacity policy that aggressively recruits HRHA to reach universal ART coverage quickly. Without such a policy, TasP roll-out can increase health losses by crowding out sicker patients from treatment, unless a surge capacity exclusively for TasP is also created.
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.|Africa Health Research Institute (AHRI), Mtubatuba, KwaZulu Natal, South Africa.|Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: David E
authors.initials: DE
authors.lastname: Bloom
authors.affiliation: Amazon.com, Inc., Seattle, Washington, United States of America.
authors.forename: Salal
authors.identifier: http://orcid.org/0000-0002-9354-5389
authors.initials: S
authors.lastname: Humair
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000191:economics; D000293:Adolescent; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000379:methods*; D003141:Communicable Diseases / Q000188:drug therapy / Q000191:economics / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D013019:South Africa; D019472:Universal Health Insurance / Q000191:economics
chemical_list: D019380:Anti-HIV Agents