Patient- and population-level health consequences of discontinuing antiretroviral therapy
While ART access has expanded, questions remain regarding continued treatment gaps and trade-offs between treatment options. As funding for HIV-programs have recently plateaued – and in some case begun to decrease – these questions have become more pressing. Motivated by specific concerns over discontinuation of ART after treatment failure, a team of investigators - including CHDS faculty - provided insight into the necessary balance between maximizing outcomes of currently treated individual patients, while continuing to provide adequate access of care at the population-level. In a recent article in Cost Effectiveness Resource Allocation, the investigators, led by April Kimmel, utilized a two-stage modeling approach. Initially, they simulated constraint-free treatment of a group of recently HIV-infected individuals. They then modeled different levels and types of treatment with varying care limitations. The results highlighted an important distinction: while treatment discontinuation negatively affected outcomes of the individual patients, it increased the total number of individuals within the cohort who received treatment, and was correlated with an increase in the overall life expectancy of the cohort. While further research is needed, these findings raise vital questions regarding tradeoffs between individual and population-level care provision, as well as issues of efficiency and equity.