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15 - Benefits and Costs of the HIV/AIDS Targets for the Post-2015 Development Agenda
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- By Pascal Geldsetzer, Research Fellow, Harvard T.H. Chan School of Public Health, Massachusetts, USA, David E. Bloom, Clarence James Gamble Professor of Economics and Demography, Harvard T.H. Chan School of Public Health, Massachusetts, USA, Salal Humair, Senior Principal Research Scientist, Amazon.com, Inc., Till Bärnighausen, Alexander von Humboldt University Professor of Global Health, Heidelberg University, Germany and Adjunct Professor of Global Health, Harvard T.H. Chan School of Public Health, Massachusetts, USA and Lead for health systems research and impact evaluation, Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Edited by Bjorn Lomborg, Copenhagen Business School
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- Book:
- Prioritizing Development
- Published online:
- 30 May 2018
- Print publication:
- 07 June 2018, pp 277-286
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- Chapter
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Summary
Introduction
Thirty years after the human immunodeficiency virus (HIV) was first identified, the HIV epidemic continues to cause large-scale human suffering and economic losses. Since featuring prominently in the MDGs, HIV has received unprecedented global political and financial commitment, being allocated 25 percent of all international assistance for health in 2011. But, despite significant successes, the goal will not be achieved, and the HIV epidemic in sub- Saharan Africa is still one of the most important causes of loss of life and health. The global HIV response will thus have to be a major continued focus of national and international development strategies after 2015.
Two Goals to Address the HIV Epidemic in the Most Affected Countries
Sub-Saharan Africa is home to 70 percent of those living with HIV globally (UNAIDS, 2013b). Within Africa, the Southern region has been hit hardest by the epidemic, with Botswana, Lesotho, South Africa, Swaziland, and Zimbabwe being termed hyperendemic (having an HIV prevalence greater than 15 percent among the adult population). We recommend two goals to address this:
Goal 1: Achieve ART (antiretroviral therapy) coverage of at least 90 percent among HIV-infected adults with a CD4 count <350 cells/μL before expanding the HIV treatment scale-up to people with higher CD4 counts.
Goal 2: Attain circumcision coverage of at least 90 percent among HIV-uninfected adult men.
Why Focus ART First on Those Most in Need?
Since the advent of ART, the WHO has gradually increased its recommended threshold for starting patients on ART to include increasingly healthy patients. WHO treatment thresholds are based on the CD4 count, a cell count that decreases in concentration with deteriorating immune system function. In 2011, a clinical trial, hailed as a game changer in the HIV field, provided evidence for even earlier initiation of ART. It showed that providing ART early in the course of the disease reduces the chance of an infected person passing HIV to an uninfected partner by 96 percent (Cohen et al., 2011). Currently, several large ongoing trials aim to establish the causal effect of providing ART to all HIV patients regardless of CD4 count, i.e., Treatment as Prevention (TasP), when implemented at the population level in sub-Saharan Africa (Essex, DeGruttola, Lebelonyane, and Habibi, 2013; Havlir and Kamya, 2013; Hayes et al., 2014; Iwuji et al., 2013; Stop AIDS Now! 2014).
Chapter 15 - Benefits and Costs of the HIV/AIDS Targets for the Post-2015 Development Agenda
- Edited by Bjorn Lomborg, Copenhagen Business School
-
- Book:
- Prioritizing Development
- Published online:
- 30 May 2018
- Print publication:
- 07 June 2018, pp 277-286
-
- Chapter
- Export citation
-
Summary
Thirty years after the human immunodeficiency virus (HIV) was first identified, the HIV epidemic continues to cause large-scale human suffering and economic losses. Since featuring prominently in the MDGs, HIV has received unprecedented global political and financial commitment, being allocated 25% of all international assistance for health in 2011. But, despite significant successes, the goal will not be achieved and the HIV epidemic in sub-Saharan Africa is still one of the most important causes of loss of life and health. The global HIV response will thus have to be a major continued focus of national and international development strategies after 2015.
Solving constraint satisfaction problems using ATeams
- Sreenivasa Rao Gorti, Salal Humair, Ram D. Sriram, Sarosh Talukdar, Sesh Murthy
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This paper presents an approach to solving constraint satisfaction problems using Asynchronous Teams of autonomous agents (ATeams). The focus for the constraint satisfaction problem is derived from an effort to support spatial layout generation in a conceptual design framework. The constraint specification allows a high-level representation and manipulation of qualitative geometric information. We present a computational technique based on ATeams to instantiate solutions to the constraint satisfaction problem. The technique uses a search for a solution in numerical space. This permits us to handle both qualitative relationships and numerical constraints in a unified framework. We show that simple knowledge, about human spatial reasoning and about the nature of arithmetic operators can be hierarchically encapsulated and exploited efficiently in the search. An example illustrates the generality of the approach for conceptual design. We also present empirical studies that contrast the efficiency of ATeams with a search based on genetic algorithms. Based on these preliminary results, we argue that the ATeams approach elegantly handles arbitrary sets of constraints, is computationally efficient, and hence merits further investigation.