Ferdinand Mkumbang

The abstracts looked at the impact and effectiveness of (1) conditional cash transfer on the HIV incidence, mortality and case-fatality rates; (2) offering bNAb HIV prophylaxis to infants; (3) CAB-LA compared to TDF/FTC over a 20-year time horizon; (4) the variation in average unit prices of ART in LMICs.

The first presentations looked at the impact of conditional cash transfer on the HIV incidence, mortality and case-fatality rates in a cohort in Brazil. Using multi-variate poison regression models, the authors found that receiving conditional cash flow transfers significantly reduced the HIV incidence, mortality and case-fatality rates for people living in extreme poverty. Looking at the impact and cost-effectiveness of offering bNAb HIV prophylaxis to infants, the presenters found that offering bNAb HIV prophylaxis to infants with known HIV exposure can be cost-effective especially where maternal HIV prevalence is high. The CAB-LA study indicated that CAB-LA is highly effective in preventing HIV transmissions; estimated at three to five-fold increase in averting HIV infections and AIDS death over 20 years. It was, nevertheless, found that the CAB-LA injection at their currently listed price in the US are unaffordable for low- and middle-income countries. Regarding the variation in average unit prices of ART in LMICs, it was found that the number of ARV combinations for first-line treatment is lower than in previous years. Nevertheless, second-line regimens remain three times more expensive in LMICs and eight times more expensive that first-line regimens in HICs.

In the context of rising global poverty rates exacerbated by the COVID-19 pandemic and impending global recession, cash flow transfers can mitigate the potential increases in HIV morbidity and mortality. Also, that the cost-effectiveness bNAb strategies can substantially reduce projected vertical transmission. The manufacturers of CAB-LA should be willing to provide voluntary licensing with the Medicines Patent Pool to improve the affordability of CAB-LA in LMICs. Countries should strengthen their HIV treatment adherence programs for more effective adherence of first-line ART adherence and to continue efficient procurement practices using economy of scale through reduced number of ART combinations.