Cost-effective: HIV tests for all in India

In India most people who are HIV positive don’t know it, yet testing and treatment are relatively cheap and available. It would therefore meet international standards of cost-effectiveness - and save millions of lives for decades - to test every person in the billion-plus population every five years according to a new study published in the journal PLoS One.

The findings are based on a careful analysis of India’s HIV epidemic using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model, a sophisticated statistical tool that has already been used in HIV policymaking in France, South Africa, and other countries. A team of researchers at Brown, Yale, Massachusetts General Hospital, Harvard, and in Chennai, India, integrated scores of factors specific to the country to find that testing for the whole country, with greater frequency for high-risk groups and areas, would pay off despite India’s huge population and even in cases where conditions are worse than the researchers assume.

“Testing even 800 million adults is a public health undertaking of a historic magnitude,” said study co-lead author Dr. Kartik Venkatesh, a postdoctoral fellow at Brown University and Women & Infants Hospital. Jessica Becker of Yale University is the other lead author of the study, which first appeared May 31. “But what we were able to show is that even if you increase the cost of HIV treatment and care pretty significantly and really decrease the number of individuals who would link to care, even under those dire circumstances, testing this frequently and this widely still was reasonable.”

Co-author Dr. Soumya Swaminathan, director of the National Institute for Research in Tuberculosis in Chennai, India, said the projections of the model will help the country in its battle with the epidemic, one of the world’s largest.

“The paper explores various strategies and suggests cost-effective options for HIV testing in India,” Swaminathan said. “As India moves ahead in its HIV prevention activities and aims for zero new infections, expanding testing will be a key priority and this analysis should help policymakers make the best decisions.”

Dollars per life-years saved

The main results from the model are projections of the dollar cost per year of extended lifespan. The World Health Organization’s standard for cost effectiveness is an expenditure that is less than three times the per capita GDP of a country. In India in 2010, per capita GDP was $1,300. A program is therefore cost-effective in India if the expense is less than $3,900 to save a year of someone’s life.

Modern antiretroviral therapies can give HIV-positive people a normal lifespan, and in India, which has a thriving generic pharmaceutical sector, first-line therapy costs only $8.61 a month (second-line therapy for those whose viruses prove resistant is $55.12 a month). HIV tests, meanwhile, cost only $3.33.