The relation of price of antiretroviral drugs and foreign assistance with coverage of HIV treatment in Africa: retrospective study
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6218 (Published 18 November 2010) Cite this as: BMJ 2010;341:c6218
- Eran Bendavid, assistant professor12,
- Eric Leroux, medical student3,
- Jay Bhattacharya, associate professor24,
- Nicole Smith, research associate2,
- Grant Miller, assistant professor24
- 1Division of General Internal Medicine, Stanford University, Stanford, CA 94305, USA
- 2Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University
- 3Stanford Medical School, Stanford
- 4National Bureau of Economic Research, Stanford
- Correspondence to: E Bendavid ebd{at}stanford.edu
- Accepted 14 September 2010
Abstract
Objective To determine the association of reductions in price of antiretroviral drugs and foreign assistance for HIV with coverage of antiretroviral treatment.
Design Retrospective study.
Setting Africa.
Participants 13 African countries, 2003-8.
Main outcome measures A price index of first line antiretroviral therapy with data on foreign assistance for HIV was used to estimate the associations of prices and foreign assistance with antiretroviral coverage (percentage of people with advanced HIV infection receiving antiretroviral therapy), controlling for national public health spending, HIV prevalence, governance, and fixed effects for countries and years.
Results Between 2003 and 2008 the annual price of first line antiretroviral therapy decreased from $1177 (£733; €844) to $96 and foreign assistance for HIV per capita increased from $0.4 to $13.8. At an annual price of $100, a $10 decrease was associated with a 0.16% adjusted increase in coverage (95% confidence interval 0.11% to 0.20%; 0.19% unadjusted, 0.14% to 0.24%). Each additional $1 per capita in foreign assistance for HIV was associated with a 1.0% adjusted increase in coverage (0.7% to 1.2%; 1.4% unadjusted, 1.1% to 1.6%). If the annual price of antiretroviral therapy stayed at $100, foreign assistance would need to quadruple to $64 per capita to be associated with universal coverage. Government effectiveness and national public health expenditures were also positively associated with increasing coverage.
Conclusions Reductions in price of antiretroviral drugs were important in broadening coverage of HIV treatment in Africa from 2003 to 2008, but their future role may be limited. Foreign assistance and national public health expenditures for HIV seem more important in expanding future coverage.
Footnotes
We thank Kanaka Shetty of RAND (Research ANd Development) for insightful comments.
Contributors: EB analysed the data and wrote the manuscript. EL collected the data and was involved in critical revisions. JB was involved in conceptualising and formulating the principal issues. NS collected and synthesised the price data. GM obtained the data, formulated the concept, and was involved in critical revisions. EB had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. EB is guarantor.
Funding: EB is supported by the National Institute of Allergy and Infectious Diseases (K01-AI084582). GM and JB receive support from the National Institute of Child Health and Development. All three receive support from the National Institute of Aging and the Center on the Demography and Economics of Health and Aging (P30-AG17253).
Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any company for the submitted work; no financial relationships with any companies that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: This study was determined to be of non-human participation by the institutional review board at Stanford University.
Data sharing: Analytical dataset available on request from corresponding author at ebd{at}stanford.edu.
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