Free antiretrovirals as a key tool against the HIV pandemic: A systematic review

BACKGROUND/OBJECTIVES: Access to antiretroviral (ARV) drugs remains a critical challenge in achieving the WHO/UNAIDS 95-95-95 targets, with medication costs representing a substantial barrier. This systematic review evaluates the effect of free ARVs, without out-of-pocket cost to the patient, on the HIV cascade of care: the use of ARV therapy, viral suppression and the use of prophylaxis (PrEP). METHODS: The following databases were searched for publications between 1 January 1996 and 10 July 2024: MEDLINE, Embase, CINAHL, CNKI, Global Index Medicus, the Web of Science, the SciELO Citation Index and grey literature. Publications were eligible if they included people living with or at risk of HIV and compared free access to ARVs with out-of-pocket fees. Reviewers screened publications that focused on the outcomes: being on therapy, being virally suppressed and being on PrEP. The National Heart, Lung and Blood Institute (NHLBI) and Joanna Briggs Institute (JBI) Quality Assessment Tools were used to assess publication quality. RESULTS: A total of 34164 documents were identified, and 407 full-text manuscripts were reviewed. A total of 22 publications met the inclusion criteria. In six of the seven publications reporting on being on therapy, providing free ARVs increased the number of people who received treatment. All four publications reporting on viral suppression showed improvement with free access. Additionally, both publications reporting on PrEP use showed increased utilization with free access. CONCLUSIONS: The review offers valuable insights for countries considering implementing free ARV programmes. It suggests that expanding access to free ARVs helps achieve the global HIV targets and improve health outcomes.

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • General HIV+ population
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Retention in care
  • Treatment
• Prevention
  • Biomedical interventions
• Health Systems
  • Governance arrangements
  • Financial arrangements
  • Delivery arrangements