Estimating the resources required in the roll-out of universal access to antiretroviral treatment in Zimbabwe
- 1School of Public Health, Imperial College London, London, UK
- 2Biomedical Research and Training Institute, Harare, Zimbabwe
- 3District Medical Office, Mutasa, Zimbabwe
- 4Ministry for Health and Child Welfare, Zimbabwe
- Correspondence to Timothy B Hallett, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK;
Contributors All authors contributed to designing and analysing/interpreting the model and writing the manuscript. TBH constructed the first version of the model and wrote the first draft of the manuscript. SG assisted with the review of literature, contributed to development of the later version of the model and extensively revised the manuscript. SD assisted with the review of literature, checked the model for errors and extensively revised the manuscript. ESM determined the central aims of the study, contributed data and extensively revised the manuscript. OM determined the central aims of the study, contributed data and extensively revised the manuscript. GPG helped to construct the first version of the model, helped to design the first draft of the manuscript and extensively revised the manuscript.
- Accepted 10 January 2011
- Published Online First 2 June 2011
Objectives To develop projections of the resources required (person-years of drug supply and healthcare worker time) for universal access to antiretroviral treatment (ART) in Zimbabwe.
Methods A stochastic mathematical model of disease progression, diagnosis, clinical monitoring and survival in HIV infected individuals.
Findings The number of patients receiving ART is determined by many factors, including the strategy of the ART programme (method of initiation, frequency of patient monitoring, ability to include patients diagnosed before ART became available), other healthcare services (referral rates from antenatal clinics, uptake of HIV testing), demographic and epidemiological conditions (past and future trends in incidence rates and population growth) as well as the medical impact of ART (average survival and the relationship with CD4 count when initiated). The variations in these factors lead to substantial differences in long-term projections; with universal access by 2010 and no further prevention interventions, between 370 000 and almost 2 million patients could be receiving treatment in 2030—a fivefold difference. Under universal access, by 2010 each doctor will initiate ART for up to two patients every day and the case-load for nurses will at least triple as more patients enter care and start treatment.
Conclusions The resources required by ART programmes are great and depend on the healthcare systems and the demographic/epidemiological context. This leads to considerable uncertainty in long-term projections and large variation in the resources required in different countries and over time. Understanding how current practices relate to future resource requirements can help optimise ART programmes and inform long-term public health planning.
Funding The Wellcome Trust and the Medical Research Council.
Competing interests We declare that there are no conflicts of interest. SG owns shares in GlaxoSmithKline and Astra Zeneca.
Provenance and peer review Not commissioned; externally peer reviewed.