Long Term Combat of HIV/AIDS : An HIV Expense Cushioning Eect [Government and Insurance Industry Cost sharing Mechanism]

Baloi L. and Kgosimore M. August 31, 2011

Background and information

HIV/AIDS discovered in the early 1980s has now established itself as a serious public health challenge requiring to be classied as a chronic disease. The disease is very expensive once infected subjects develop Full Blown AIDS. Issues of economic melt-down have compounded problems of funding for HIV treatment programmes. In various spheres the current state of the epidemic and continued high levels of new infections on yearly basis with resource-poor countries or countries with high level incidence and prevalence rates; the main question is can governments sustain the HIV/AIDS epidemic. Ironically, that questions seem to have an optimistic no. The follow-up question then is what other alternatives methodologies or interventions can be put in place to mitigate against the eventual bleak future of sustaining the epidemic. The proposed problem wishes to bring alternative approaches to planning, evaluation and monitoring of the epidemic, in the context of economics and battle-eld mathematical models or predator-prey models. The approach considers the role of partnerships of government, insurance service providers and the civic society in investing in public health with emphasis on HIV/AIDS, which has a signicant bearing on socio-economic attributes of the society. The long term problem considers investment and recovery of monetary resources and reduction of man-lives. This can be achieved or realized in the long term investment prior to the development of the disease. The expense cushioning eect can be achieved through investment in medical insurances. The incubation period of HIV/AIDS is roughly 10 years. This long incubation period allows for an accrual of necessary nances to ght the disease at a later stage. Our argument is that if there is a national medical insurance the invested funds can later be used 1

to ght the disease or avail anti-retroviral drugs. To visualize the problem a simplistic model using the pigeon hole principle can be envisioned and models as Pn = 1 +
r 100 n

(1)

where P is the principal value (or initial value), r annual rate of investment, n duration of investment in years and Pn investment maturity value after n years.

Problem statement

We consider a SEIR model with three classes described as follows: A susceptible population (S ), individuals in the class are free from infection and are at risk of acquiring infection upon interaction with infected individuals; the asymptomatic HIV infected population, (E ), individuals in this class are infected with no clinical signs, infectious but they may be unaware of their HIV status; the symptomatic infected population (I ) have clinical signs and are highly infectious. Treatment of HIV usually start in this class leading to a class of Treated individuals (T ), which may eventually progress to the class or removals. Treatment in a way plays a crucial role of delaying death; and full Blown AIDS population (R) usually referred to as removal class, are mostly bed-ridden and play minimal role in the transmission dynamics of the disease.

2.1

Model assumptions

The problem relaxed other related costs such those of hospitalizations, development of drug resistance due to lack of adherence and other eects like drug toxicity.

3
3.1

Methodology
Cost measurement criterion
1. The cost of anti-retroviral drugs 2. Reduction of progression to death (or reduction in disease related rates)

The main aim of provision of drugs is reduce the level of infectiousness (form of prevention mechanism against those at risk) and reduce the disease related deaths (prolonged lifeexpectancy). We therefore need to formulate multiple control functions that maximize these benets against the high cost of anti-retroviral drugs. We propose a control function of the form (2) j = 01 bu2 dt + (1 b)x(t) 2

The study discusses control problems (i) Jc describing the cost of ARV control function (ii) Jd describing the reduction in diseases related deaths control function and (iii) Jp describing the preventive mechanism control function due reduced level of infectiousness. So that we consider a mathematical problem j = Jc Jd Jp which over a long time would not be economically viable with increased number of infections and cost of ARVs. We visualize this problem in the context Laws of supply and demand and other economies of scale, raw materials, over time for hospital personnel and labour implications also compound to the cost factor blowing it further. Other, anticipated challenges can arise from viral rebound or drug resistance leading to acquisition of new and expensive drug combinations. It is notable to have an ever increasing control functions with no upper bounds and optimal solutions as the functions will not be integrable in all spaces. However smoothing functions involving fourier series summations may be used to overcome discontinuities of the functions. This description is consistent with current situations.

3.2

Solution approach

The methods of solution will involve determination of model equilibria or study the different scenarios emanating from (a) adequate resources and disease outcome (b) eects of inadequate monetary resources on the severity of the epidemic as inuenced by disease incidence, prevalence and deaths and (c) evolution of drug resistance as a result of inadequate drugs and money. We wish to explore dierent approaches such as 1. Application of battle modelling approaches with investments representing paratrooper actions 2. Predator-prey models with HIV/AIDS preying on both resources and funds 3. Application of stochastic models

Objectives

The main objective of the study is to determine an optimal strategy to sustain the epidemic and eectively reduce the proportion dying of the disease to a lower predetermined value ( < ).