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An ounce of prevention no longer worth a pound of cure?

7 August 2009

So much of the money for HIV/AIDS interventions is spent on treating the sick that I wonder how much we value prevention. Recent work modeling the impact of immediate availability of antiretroviral therapy on HIV incidence suggest treating the HIV-infected would curb transmission (see January 2009 issue of The Lancet). Mead Over at the Center for Global Development asks whether a new NIH-funded study to be conducted by researchers at UNC will have convincing evidence on whether immediate treatment slows transmission, and both of us agree that the sample the researchers will draw will have to be larger in order to have the statistical power to make a convincing argument.

A program that would use AIDS treatment to also prevent the spread of HIV meets both the objective to reduce incidence and the objective to take care of the sick; usually the debate is on how much to spend on one versus the other. Nandini Ooman from CGDev points out recent data from the US shows we are spending little on prevention, and reports show the general funding of research and development for HIV prevention have declined for the first time ever, though international AIDS assistance is still on the rise. Obviously, the increased funding is going towards treatment.

Treatment is expensive, and as of yet, we don’t know if it’s effective in curbing transmission of HIV. Certainly, the proposed UNC study is a step in the direction of testing empirically the external validity of mathematical models predicting reduced HIV incidence with increased AIDS treatment. It’s a rather costly way to go about testing a provocative idea, and I simply wonder if we could instead use that funding to carefully measure the impact of purely prevention-oriented interventions — and I also wonder how many such careful tests we could fund for the same cost as the proposed UNC study.

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