The World Health Organization’s “90-90-90” treatment targets for HIV, which aim to have 81% of people living with HIV on antiretroviral therapy by 2020, may be financially unachievable, according to modeling that predicts a potential resources shortfall of up to US$25 billion.
A modeling analysis of the financial resources needed to scale up antiretroviral therapy (ART) in 97 countries to meet the WHO targets for 2015-2020 suggests that, under the 90-90-90 scenario, 30.4 million adults and 1.68 million children could receive treatment by 2020, which would require an estimated US$52.5 billion, according to a paper published Nov. 24 in PLoS Medicine.
When current funding trends were taken into account, the analysis predicted financing gaps ranging from US$19.8 billion to US$25 billion, with up to a US$16.8 billion gap for ART alone (PLoS Med. 2015 Nov 24;12. doi:10.1371/journal.pmed.1001907).
The analysis estimated the number of individuals eligible for and receiving treatment and the cost of providing antiretroviral therapy, but it also looked at the full spectrum of costs in delivering therapy, including diagnostic supplies, and factored in predictions for shifts in epidemics. The 90-90-90 treatment scenario envisions 90% of all people living with HIV knowing their status, 90% of all people diagnosed with HIV infection receiving antiretroviral therapy, and 90% of all people receiving ART having robust viral suppression.
“Our estimates of the resource requirements for ART suggest that the financial sustainability of a scaled-up global ART response, where the scale-up itself is cost-effective, may be at risk without either additional resource mobilization or efficiency and effectiveness gains,” wrote Arin Dutta, senior technical director at Palladium in Washington, D.C., and his coauthors.
The study was funded by the U.S. Agency for International Development. No conflicts of interest were declared.