The cost of removing financial barriers to treatment uptake and adherence as effective public health strategies for improving health and reducing HIV transmission in Australia Lance Feeney - Positive Life NSW (No conflicts of interest to declare)

Background The Australian Seventh National HIV Strategy targets NSW HIV Strategy : A New Era Australian PBS subsidised medicines (patient co-payment) Financial stress and cost of ART co-payments are barriers to treatment uptake and adherence PLHIV experience higher rates of co-morbidity Decisions about ART initiation and adherence are negatively impacted by cost of ART and non-ART medications

Background cont. A case for Australian Governments reducing the cost burden of ART, particularly for those experiencing financial stress Annual cost of each new HIV infection is $13,800 - $16,300 for those on 1 st or 2 nd line ART Annual cost for those on 3 rd line ART is $19,000 The life time cost of each new HIV infection is estimated to be approximately $483,000 - $570,000 (1 st /2 nd ) and $665,000 (3 rd line ART)

Methods PBS Co-payment rates & employment percentages Number of ART items dispensed per person

Full and Concessional patient cost for ART/non-ART medications over 12 months

Yearly cost to Government of waiving ART co-payments for 10,500 people with diagnosed HIV in NSW

Yearly cost to Government of waiving co-payments for 15%-20% of people with undiagnosed HIV in NSW So for less than $6 million per year 90% of all people with diagnosed and undiagnosed HIV could be treated free It could cost $5.2 million per year at 80% treatment uptake

Progress in other Australian States and Territories  New South Wales -  Victoria - Detailed analysis commissioned by Victorian AIDS Council and Living Positive Victoria and conducted by Burnet Institute  Queensland – Proposal viewed with merit, but yet to be approved for implementation  South Australia – Positive Life South Australia developing state-based submission  Western Australia – ART co-payments waived  Northern Territory – ART co-payments waived  Tasmania and the Australian Capital Territory ?

Conclusion Mixed result to reduce cART cost burden Improving rates of ART in NSW But, still PLHIV minority with poorer health, drug and alcohol and poverty issues Achieving 2015 treatment and prevention targets will require addressing barriers to cART A case to build this into the public health response

Acknowledgments Jo Watson – NAPWHA (co-author) Bill Whittaker – NAPWHA Albion Centre Pharmacy St. Vincent’s Hospital Pharmacy PozAction members: o Queensland Positive People o Living Positive Victoria o Positive Life South Australia