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The impact and cost of the 2013 WHO recommendations on eligibility for antiretroviral therapy

Stover, Johna; Gopalappa, Chaitraa; Mahy, Maryb; Doherty, Meg C.c; Easterbrook, Philippa J.c; Weiler, Gundoc; Ghys, Peter D.b

doi: 10.1097/QAD.0000000000000235
Adoption and implementation
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Objectives: The present study presents estimates of the number of people who would become newly eligible for antiretroviral therapy if all countries adopted the 2013 WHO treatment guidelines. It also shows the cost and impact that would result if coverage expanded to 80% of those eligible.

Methods: The AIDS Impact Model (AIM) and the Goals model within the Spectrum modelling system were used for these estimates. Projections of costs and AIDS deaths are based on estimates for 116 low-income and middle-income countries. Projections of impact on HIV incidence are based on simulation modelling for 24 high burden countries, with the results scaled up to represent all low-income and middle-income countries.

Results: If the 2013 guidelines were adopted universally, the number eligible for treatment would rise to 28.6 million in 2013. Achieving 80% coverage would mean 28 million on antiretroviral therapy by 2025, and would avert 2.9 million deaths and 3.9 million new infections from 2013 to 2025 compared with the 2010 guidelines.

Conclusion: The 2013 guidelines significantly expand the number eligible for treatment. Reaching those newly eligible will require additional resources, but is likely to produce significant benefits.

aFutures Institute, Glastonbury, Connecticut, USA


cHIV Department, World Health Organization, Geneva, Switzerland.

Correspondence to John Stover, Futures Institute, 41A New London Turnpike, Glastonbury, CT 06033, USA. E-mail:

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© 2014 Lippincott Williams & Wilkins, Inc.