Economics

Overview

Globally 35 million people have died to HIV while 36.7 million continue to live with the disease today (WHO). Of these millions, sub-Saharan Africa has been disproportionally affected with the United States also significantly affected (1.1 million) (CDC) compared to other modernized countries. Although Antiretroviral drugs can effectively treat the disease, the sad truth is that for Sub-Saharan Africa testing for HIV is often not a very easy prospect. In fact, testing for HIV in sub-Saharan Africa is limited by a variety of socioeconomic factors. These factors not only include the direct cost associated with HIV testing but also the stigmatization of HIV and HIV testing within the social groups of individuals in Africa. These barriers to testing necessarily make the treatment of HIV and the resulting spread of the disease far more difficult to manage. As such the goal of a point of care rapid diagnostics test that is accurate, cheap, and convenient is critical to combat the spread of the virus.

Needless to say, however, is the economic toll this has taken on the region. As one of the most impoverished regions of the world, economic growth is among one of the top priorities for the area. South Africa, the most economically developed country in the region, has experienced an increasing prevalence of HIV: an ever-increasing burden on a still growing economy (1). As HIV prevalence grows, so too does the prevalence of AIDS and thus AIDS-related death and illnesses. The direct cost can be associated with the amount of money sunk into testing, antiretroviral, and the campaigns against the disease. However, for the majority of these, the cost is covered by NGOs. The true cost associated with the disease is the loss of productive years and life across all afflicted individuals.

This loss of life and productivity is only the surface of what the disease truly does to these still-developing economies. The economic capacity, that is to say, the ability for an economy to produce is severely impacted by those factors affecting the working population. HIV/AIDS erodes at the human aspect of capacity and can substantially hobble economic growth rates(1). This in turn further deepens the problem of combatting the disease as there is less economic might to do so.

The current system in place across all of sub-Saharan Africa further exacerbates this problem as well. A majority of individuals afflicted with HIV or think that they are HIV positive must contend with drastically shortened lifespans. This is something that is a reality made possible by the stigmatization of HIV in the region. Without treatment, infected individuals face a far shorter lifespan. In Uganda, for instance, HIV is a taboo topic where individuals who think they have the virus are less likely to test themselves (2).

Fundamentally, the issue is that this is a widespread disease that is debilitating and without treatment rapidly reduces lifespan. As a result, the population that would have been able to contribute to the economic growth of the area can no longer do so. This effect is multiplied for each afflicted individual. Across sub-Saharan Africa, with so many of these individuals, the loss of economic growth is staggering.

Uganda

Uganda along has a known HIV positive population of 1.5 million with 28,000 AIDS-related deaths in 2016. Furthermore, recent research has indicated that, although the number of infections per year is now falling, this trend will reverse itself in the coming years. (2) Although people have had increasing access to treatment in recent years, there are still groups that are disproportionately affected by the disease.

Men who have intercourse with other men are among the discriminated in Uganda, and experience a prevalence of HIV estimated at 13% in 2013. (2) Although the proportion of these individuals testing has gone up according to a 2011 survey, the reliability of these results for the whole country is not very high. In 2013 the Uganda Anit-Homosexuality Act was passed by the parliament and although it was annulled due to a technicality the effects still remain.

Sex workers, by the same token, also make up one of the most affected populations in the country. Attitudes towards sex work as well as the economic situation of many women facilitate the rampant spread of the disease with an estimated 35-37% incidence in 2014. (2) It was estimated that sex workers and their clients account for 16% of new infections in Uganda with a great financial incentive placed on sex workers not to practice safe sex. Furthermore, the criminalization of sex work also puts a strain on the ability for individuals to actually receive help for HIV.

Aside from men that have sex with other men and sex workers, Adolescent girls and young women, people who inject drugs, and children of mothers with HIV are all groups that are unusually vulnerable to the HIV in Uganda. This country, more than others of the region, has much more information regarding the subject of HIV. This a result of its vigorous campaign against HIV/AIDS, however, the disease is still a highly debilitating one both individually and collectively.

South Africa

5.7 of 48 million South Africans currently live with HIV. It has been projected that, in spite of recent declines in HIV prevalence, there will be an increase in the prevalence of HIV in the years to come (1). As is natural with diseases such as HIV the poor and the working class are disproportionately affected. Lack of access to information and treatment for the disease leaves this group disproportionately affected (3). This in turn, for reasons discussed in the overview, decreases the life expectancy of those of the working class within the country. This implies increased training cost as each individuals working life is shorter and training must be conducted more often (1).

Furthermore, among those at the lower end of the Socio-economic index (SEI) the prevalence of HIV infection was almost double that of the country while the middle class (middle SEI) had an infection rate of 15.9 % (3). These numbers are likely to be higher than what was measured. This is likely because of testing as not only is there consistently higher stigma towards HIV at a lower SEI there is less access to information as well. Furthermore, testing among low SEI men in particular lags behind all other groups (4).

Fundamentally the issue comes down to access. Low SEI individuals have lower access information and as a result, have a greater stigma for the disease (4). It is these factors, that are tied most closely with the prevalence of HIV within the country. HIV can hobble the economic growth of any country (1), and, with a disproportionately affected working population, it can affect South Africa even more deeply. This is a danger of HIV, it is a disease that affects the individual and the collective insidiously.

The Congo

The Congo provides an interesting case study of the effects of HIV in a situation where the government cannot provide. So affected by social and political instability, foreign aid is difficult to deliver; to say nothing of the health care a stable government is able to facilitate. The Congo provides an example of HIV left alone to run rampant.

Although many studies have been conducted with regard to HIV in the Congo, sampling methods have been greatly affected by instability making it difficult to track HIV in regions of active conflict. However, one study finds that, although there is an overall prevalence of HIV less than two percent, there is a high degree of heterogeneity with regard to the spread of HIV cases. In some regions, up to thirty percent of people may be infected. Furthermore, this number is not homogenous across genders either. In some regions, men are disproportionately affected while in others it is women that are most affected.

HIV in the Congo is difficult to track but the heterogeneity of the spread of the disease is clear. Furthermore, according to the study, it appears that proximity to a city is a key factor for women. A greater proximity is associated with a higher incidence of HIV. This will have implications for when the conflict ends. (5) During times of conflict, cities are targets of high value and this heavily impacts short-term migratory patterns. If the conflict comes to an end, there is a strong likelihood that the population of the country will migrate back to the cities. As the higher incidence of HIV in urban areas is associated with patterns of riskier sex practices, there is the possibility that a time of sustained peace could lead to a spike in HIV incidence within the population.

As discussed in (1) the issue that HIV presents, especially in growing economies, relates fundamentally to shortened lifespan and lowered quality of life. As jobs continue to aggregate in cities, so too will the population. As such, the potential damage HIV will do to the economic growth/recovery of the Congo could be devastating.

United States

The United States uniquely differs from the countries of Africa in that researchers simply have a greater capacity to do research in the country. In fact, a far greater variety of information can be specified by American Studies. Although these studies do not necessarily reflect our region of interest, they do provide accurate data on the economic burdens associated with HIV in a country with a relatively developed healthcare system and a relatively high growth rate. This is a very best-case scenario.

Estimated costs to a person across they’re entire lifetime vary based on the initial CD4 count. With a high initial CD4 count (greater than 500 cells/uL), one may expect a lifetime cost of $361,944 and a life expectancy of 24.4 years. Without receiving ARVs both cost and life expectancy drop to $145,218 and 12.4 years respectively. The cost of treatment will go down with a decreased CD4 count, however as will life expectancy will drop precipitously.

Table 1. Courtesy of source 6 (Direct cost of ART in USD within the united states)

However, the direct cost to the individual are only the tip of the iceberg. Rather, much of the cost is concentrated in the productivity loss. Across all ethnic groups, the loss of productivity has a consistent price tag greater than $500,000 with blacks and Hispanics nearing $1,000,000. The overall cost of these factors, however, exceeds these simple values. The indirect burden from HIV/AIDS is underestimated as it is the potential of the future that HIV kills. Even in the United States, the effect of HIV is something great and unfathomable. One can only imagine the effects of this on those countries not as well off. (6)

What We Do

This project primarily concerns itself with the creation of an RDT capable of detecting HIV infection within as little as a week after infection. Furthermore, this test will have a specificity that exceeds 95%. As a result, not only is it able to identify the presence of HIV quickly but also accurately. As a result, individuals who identify the viral presence earlier will have a necessarily higher CD4 count. As a result, life expectancy can be expected to improve.

Moreover, the cost with which this test can be produced would allow for widespread use within the countries of sub-Saharan Africa. Combined with the provision of ARVs by foreign NGOs, the indirect costs associated with HIV can be staved off without these countries shouldering too much of the direct medical costs. This can mitigate much of the costs associated with the proliferation of HIV within these countries and facilitate. Thus the combination of these factors allows for a greater degree of economic growth across all countries within the affected regions.

This, however, is only the tip of the iceberg. The specific RDT designed by our team is not only cheaper than current options but can also diagnose HIV earlier. As a result, the test designed by our team is not only an effective solution for sub-Saharan Africa but also the United States. Furthermore, the modularity of the test allows for its use to be expanded to identify other viruses including ZIKV. As a result, this testing tool can be considered objectively better than most diagnostic options for a variety of diseases.

However, we do not stop simply at modularity and efficacy. Our project pays special attention to the direct cost of the test such that it can be easily and widely distributed across an entire continent and still function in every environment. What truly separates our device from others is the specific use of thermostable GRFT. The result is a molecule that will not denature until at least 90 degrees Celsius. Typical GRFT denatures at 60 degrees Celsius.

A difference of 30 degrees ammounts to huge quantity of money. Not only does this allow for rapid purification of the protien from others that come out of e. coli, but it also allows for a greater shelf life in the sub saharan climate. Other e. coli protiens also denature at 60 degrees celsius. By being able to denature these protiens, huge sums of money may be saved on the purifcation process. Furthermore, as the highest recorded temeperature on the continent comes in at close to 60 degrees as well, we can say with almost certainty that our RDT can survive every environmental temperature fluctuation. In short, thermostable GRFT is a perfect choice for this intended function

1. Brookings Article (The Economic Impact of HIV/AIDS in Southern Africa by Barks-Ruggles and others)

2. Avert Article ( HIV and AIDS in Uganda )

3. KAS Article (The Impact of HIV/AIDS on the South African Economy by Andrea E. Ostheimer)

4. ProQuest Article (Socio-economic inequality and HIV in South Africa by Njeri Wabiri and Negussie Taffa)

5. Elsevier Article (Spatial and socio-behavioral patterns of HIV prevalence in the Democratic Republic of Congo by Messina et al.)

6. JAIDS Article (The Economic Burden of HIV in the United States in the Era of Highly Active Antiretroviral Therapy: Evidence of Continuing Racial and Ethnic Differences by Hutchinson et al.)