The Political Economy of HIV/AIDS in Developing Countries
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The Political Economy of HIV/AIDS in Developing Countries

TRIPS, Public Health Systems and Free Access

Edited by Benjamin Coriat

The book is based on original data and field studies from Brazil, Thailand, India and Sub-Saharan Africa. Focusing on the issue of universal and free access to treatment (a goal now taken to heart by the international community), it assesses the progress made and presents a rigorous diagnosis of the obstacles that remain, especially the constraints imposed by TRIPS and the poor state of most public health systems in Southern countries. In so doing, the book renews our understanding of the political economy of HIV/AIDS in these vast regions, where it continues to spread with devastating social and economic consequences.
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Chapter 9: Cost-effectiveness of HIV Antiretroviral Therapies in Resource-limited Settings

Yazdan Yazdanpanah, Caroline E. Sloan and Kenneth A. Freedberg


9. Cost-effectiveness of HIV antiretroviral therapies in resourcelimited settings Yazdan Yazdanpanah, Caroline E. Sloan and Kenneth A. Freedberg INTRODUCTION In the late 1990s and early 2000s, some argued that HIV funding in resource-limited settings should be devoted mainly to prevention and to some non-antiretroviral therapy (ART) treatment and care (Walgate, 2002; US Senate, 2003). This view was in part based on results of studies that showed that the cost of making combination ART available worldwide would be exceedingly high, and moreover that HIV prevention activities are likely to be substantially more cost-effective than provision of ART (Hogg et al., 1998; Creese et al., 2002; Marseille et al., 2002). However, these studies did not evaluate whether the provision of ART itself was costeffective, and the comparisons with prevention activities were done without standardized methods. Providing ART in resource-limited settings has, however, now become feasible, due to its dramatic survival benefits, and the fact that ART efficacy in these settings was found to be comparable to efficacy in developed countries (Laurent et al., 2002, 2004; Weidle et al., 2002; Orrell et al., 2003). Reduced drug costs and the dramatic rise in global funding for HIV/AIDS have had the biggest impact on the availability of care (Walgate, 2002; US Senate, 2003; Levi et al., 2002). Results of short-term cost studies from countries such as Brazil showed that treatment of patients with advanced AIDS, in the first several years of ART availability, was associated with important cost trade-o...

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