# Could long-acting medications facilitate "ending AIDS by 2030" in southern Africa? An allocative efficiency analysis

> **NIH NIH R01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2021 · $702,655

## Abstract

ABSTRACT/SUMMARY
In our 2018 Lancet HIV commentary (“Ending AIDS by 2030: Catchy slogan or sincere goal?"), we note that
published surveillance data together with mathematical modeling make it clear that UNAIDS 2030 goals (90%
reduction in HIV incidence) are not going to be met with current spending and resource allocation, and
UNAIDS 2020 goals (90% of infected are detected, 90% of detected are linked to care, and 90% of linked to
care are virally suppressed) are not going to be met by 2020. Existing models suggest a tripling in HIV
spending (from $12.8 billion to $40 billion per year) would be necessary to meet these goals, together with an
optimizing of that spending. Indeed, without optimization, the necessary spending for that goal would likely top
$52 billion per year.
To achieve UNAIDS 2030 goals it will be necessary to critically assess the role of all available tools and tailor
strategies to maximize their impact. However, current mathematical models omit three important tools in the
arsenal for achieving 2030 goals in resource-limited regions: (1) Specific interventions that target the HIV care
continuum (in particular specific interventions with randomized controlled-trial evidence include SMS-based
text reminders for appointments and/or medications and combination interventions similar to Link4Health
[including accelerated medication initiation, SMS-based text reminders, care/information package +/- noncash
financial incentive]), (2) targeting interventions to high risk populations (such as those with alcohol use
disorders [AUDs] and common mental disorders [CMDs]) that are specifically relevant to a region’s
demographics and policy constraints, and (3) alternate timing of the peak of HIV spending (earlier is better
because it leads to “getting ahead of the epidemic” but may be less feasible).
Accordingly, focusing on the countries of Zimbabwe, eSwatini (formerly known as Swaziland), and South Africa
(in particular, the province of KwaZulu Natal [KZN]) because of their disproportionate burden of HIV morbidity
and mortality, our proposal uses mathematical modeling to evaluate the allocative efficiency of a wide
spectrum of combination HIV prevention strategies to determine: How cost-effective would interventions
enhancing ART linkage-adherence-retention (e.g., long acting ART) need to be in order to efficiently constitute
combination HIV prevention strategy (Aim 1); How cost-effective would interventions enhancing PrEP linkage-
adherence-retention (e.g., long-acting PrEP) need to be in order to efficiently constitute combination HIV
prevention strategy (Aim 2); and how cost-effective would interventions enhancing PrEP and ART linkage-
adherence-retention need to be in order to efficiently constitute combination HIV prevention strategy (Aim 3).

## Key facts

- **NIH application ID:** 10228020
- **Project number:** 5R01AA027481-03
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Ronald Scott Braithwaite
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $702,655
- **Award type:** 5
- **Project period:** 2019-09-25 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10228020

## Citation

> US National Institutes of Health, RePORTER application 10228020, Could long-acting medications facilitate "ending AIDS by 2030" in southern Africa? An allocative efficiency analysis (5R01AA027481-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10228020. Licensed CC0.

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