Lecture 4 HIV/AIDS

Question 1

Without treatment, 3 stages

Answer 1

1. acute hiv infection
2. clinical latency
3. AIDS (when cd4 drops below 200 cells/mm3, life expectancy of 3 years or with opportunistic disease, expectancy 1 yr.)

Question 2

ART

Answer 2

controls the virus, keeps the individual healthy and reduces the risk of transmission
> Mostly effect on boys and women, boys were taken out of school, women had to work harder. If father got better, boys back to school and women back to their own job.

Question 3

90 90 90 explained

Answer 3

90% diagnosed: People need to get tested, get 90 % of the people aware that they have the disease
90% on treatment: Of 90% positives, 90% needs to get ART
90% virally suppressed: need to get the right treatment to suppress the virus
A problem with this system is that 27% is still not covered, but currently 41% is not covered so it is an improvement anyway.

Question 4

Prevention strategies

Answer 4

Nonsexual:

• prevention of transmission through blood
• prevention of mother-to-child transmission

Change sexual behaviour

• ABC: abstinence - be careful - condoms
• peer education of sex workers
• voluntary testing and counselling > reduce risky sexual behaviour
• microbicides

Question 5

Cost-effectiveness analysis

Answer 5

1: calculate the impact of a specific intervention on your outcome of interest
2: calculate the financial costs of implementing the intervention
3: calculate the financial gains from implementing the internvention
4: compare the cost-effectiveness of one intervention with another intervention

Question 6

Treatment for all as prevention (barnighausen et al) TasP

Answer 6

game changer in the fight against HIV but it is unclear how this can be financed

Question 7

Excess burden

Answer 7

the cost associated with the activities people undertake in order to avoid a disease

Question 8

epidemiological cost

Answer 8

direct costs of a disease

Question 9

Total economic cost

Answer 9

Epidemiological cost + excess burden

Question 10

SIR-model of infectious disease

Answer 10

Susceptible - Infected - Recoverd

People can move from group to group,

Question 11

Steady state of populations

Answer 11

All populations have stabilized, people still move between states, but the net number of people does not change
People shift through the groups Susceptible - Infected - Recoverd but the size of the groups stays the same

Question 12

Eradication

Answer 12

Eliminating the possibility of new infections of a disease

This requires eliminating all human and nonhuman reservoirs of the disease