Identifying key drivers of the impact of an HIV cure intervention in sub-Saharan Africa

BACKGROUND:  The properties required of an intervention that results in eradication or control of HIV in absence of antiretroviral therapy (ART-free viral suppression) to make it cost-effective in low income settings are unknown. METHODS:  We used a model of HIV and ART to investigate the effect of introducing an ART-free viral suppression intervention in 2022 in an example country of Zimbabwe. We assumed that the intervention (cost: $500) would be accessible for 90% of the population, be given to those on effective ART, have sufficient efficacy to allow ART interruption in 95%, with a rate of viral rebound 5% per year in the first three months, and a 50% decline in rate with each successive year. RESULTS:  An ART-free viral suppression intervention with these properties would result in over 0.53 million disability-adjusted-life-years averted over 2022-2042, with a reduction in HIV programme costs of $300 million (8.7% saving). An intervention of this efficacy costing anything up to $1400 is likely to be cost-effective in this setting. CONCLUSION:  Interventions aimed at curing HIV have the potential to improve overall disease burden and to reduce costs. Given the effectiveness and cost of ART, such interventions would have to be inexpensive and highly effective.