Impact of universal coverage for antiretroviral therapy (ART) on health outcomes

Abstract

As of 2017, the annual cost of single-tablet antiretrovirals (ART) in Ontario was estimated to be CAD 15,552 according to the Ontario Drug Benefit Formulary. Universal, no-cost ART for all people living with HIV in Ontario has the potential to improve access to ART among those lacking the means for deductibles and co-payments and could remove the need to join programs such as the Ontario Disability Support Program (ODSP) to obtain coverage.
High-income countries with higher ART coverage have been more likely to achieve a greater proportion of individuals that are virally suppressed, and beginning ART at the time of HIV diagnosis regardless of CD4 cell count is associated with increased viral suppression.
Expanded ART coverage in the U.S. is associated with reductions in HIV transmission, mortality, and comorbidities such as certain cancers.
In terms of costs, the scale-up of ART was found to be highly cost-effective in British Columbia; in Australia, expanding ART to temporary residents was estimated to considerably reduce HIV transmission at little additional cost. In Italy, high costs for ART was compensated for by improvements in health outcomes and reductions in health care use.

Ontario HIV Treatment Network: Rapid Response Service

2021