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Global Economic Burden of HIV/AIDS
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Global Economic Burden of HIV/AIDS

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 17517

Special Issue Editors

Dr. Emmanuel K. Peprah

E-Mail Website
Guest Editor
Implementing Sustainable Evidence-Based Interventions through Engagement (ISEE) Lab, Global Health Program, Department of Social and Behavioral Sciences, School of Global Public Health, New York University (NYU), 708 Broadway, 4th Floor, New York, NY 10003, USA
Interests: dissemination and implementation of evidence-based programs; HIV/AIDS; implementation science; inter-organizational networks; translational science
Dr. Nessa Ryan

E-Mail Website
Assistant Guest Editor
School of Global Public Health, New York University, New York, USA
Interests: gender-specific threats to health for women and girls
Dr. Joyce O. Gyamfi

E-Mail Website
Assistant Guest Editor
School of Global Public Health, New York University, New York, USA
Interests: implementing sustainable and scalable evidence-based interventions for chronic and infectious diseases in low-resource settings; implementation science; health education and promotion

Special Issue Information

Dear Colleagues，

HIV/AIDS remains one of the 10 leading global causes of early death. However, recent developments in treatment programs, including highly active antiretroviral therapy (HAART) and pre-exposure prophylaxis (PrEP), have shifted its prognosis from a death sentence to a chronic, manageable disease.

HIV/AIDS not only manifests itself physically, but also socially and psychosocially. People living with HIV/AIDS (PLHIV) have comorbid conditions (e.g., cardiovascular–pulmonary disease, sleep disorders, diabetes, neurological and musculoskeletal issues), co-infections with TB, diabetes, and other social/behavioral aspects (e.g., smoking, substance abuse) combined produce synergistic epidemics (i.e., syndemics) with documented higher rates of depression that negatively impact health outcomes. These syndemics in PLHIV impact quality of life and contribute to the economic burden of disease globally. To date, costs directly related to the clinical management of HIV/AIDS are relatively well understood; however, much remains to be studied. We invite papers that discuss the global economic burden of PLHIV in any setting. Papers that discuss collaborations with researchers, patient advocates, and public health practitioners that have implemented and analyzed the cost evidence-based interventions for prevention and treatment are welcomed. Data that address patient/family/community costs associated with expenditures other than treatment are scant, especially in low- and middle-income countries (LIMCs), where data collection tools have yet to be fully implemented. We invite papers from researchers/implementers/practitioners that discuss various elements of the economic burden for PLHIV, including treatment of comorbid conditions and how the economic burden differs based on location (e.g., high-income vs low- or middle-income countries). Papers or commentaries examining the economic burden of HIV/AIDS, using mixed methods with an emphasis on both direct and indirect costs associated with the disease in various populations are welcomed. We aim to bridge this gap in the literature by taking a comprehensive perspective that incorporates population data to help to paint a larger picture of the overall economic burden of HIV/AIDS.

Dr. Emmanuel K. Peprah
Leading Guest Editor

Dr. Nessa Ryan
Dr. Joyce O. Gyamfi
Supporting Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • HIV/AIDS
  • Economic burden
  • Socioeconomic
  • Cost analysis
  • Cost-effectiveness
  • Direct medical costs
  • Nonmedical costs
  • Productivity costs
  • DALYs (disability-adjusted life year)
  • Low-resource settings
  • Low- and middle-income countries (LMICs)
  • High-income countries

Published Papers (4 papers)

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Research

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7 pages, 457 KiB  
Article
Deconstructing Syndemics: The Many Layers of Clustering Multi-Comorbidities in People Living with HIV
by Emmanuel Peprah, Elisabet Caler, Anya Snyder and Fassil Ketema
Int. J. Environ. Res. Public Health 2020, 17(13), 4704; https://doi.org/10.3390/ijerph17134704 - 30 Jun 2020
Cited by 10 | Viewed by 4814
Abstract
The HIV epidemic has dramatically changed over the past 30 years; there are now fewer newly infected people (especially children), fewer AIDS-related deaths, and more people with HIV (PWH) receiving treatment. However, the HIV epidemic is far from over. Despite the tremendous advances [...] Read more.
The HIV epidemic has dramatically changed over the past 30 years; there are now fewer newly infected people (especially children), fewer AIDS-related deaths, and more people with HIV (PWH) receiving treatment. However, the HIV epidemic is far from over. Despite the tremendous advances in anti-retroviral therapies (ART) and the implementation of ART regimens, HIV incidence (number of new infections over a defined period of time) and prevalence (the burden of HIV infection) in certain regions of the world and socio-economic groups are still on the rise. HIV continues to disproportionally affect highly marginalized populations that constitute higher-risk and stigmatized groups, underserved and/or neglected populations. In addition, it is not uncommon for PWH to suffer enhanced debilitating conditions resulting from the synergistic interactions of both communicable diseases (CDs) and non-communicable diseases (NCDs). While research utilizing only a comorbidities framework has advanced our understanding of the biological settings of the co-occurring conditions from a molecular and mechanistic view, harmful interactions between comorbidities are often overlooked, particularly under adverse socio-economical and behavioral circumstances, likely prompting disease clustering in PWH. Synergistic epidemics (syndemics) research aims to capture these understudied interactions: the mainly non-biological aspects that are central to interpret disease clustering in the comorbidities/multi-morbidities only framework. Connecting population-level clustering of social and health problems through syndemic interventions has proved to be a critical knowledge gap that will need to be addressed in order to improve prevention and care strategies and bring us a step closer to ending the HIV epidemic. Full article
(This article belongs to the Special Issue Global Economic Burden of HIV/AIDS)
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Review

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31 pages, 3723 KiB  
Review
HIV, Tuberculosis, and Food Insecurity in Africa—A Syndemics-Based Scoping Review
by Temitope Ojo, Christina Ruan, Tania Hameed, Carly Malburg, Sukruthi Thunga, Jaimie Smith, Dorice Vieira, Anya Snyder, Siphra Jane Tampubolon, Joyce Gyamfi, Nessa Ryan, Sahnah Lim, Michele Santacatterina and Emmanuel Peprah
Int. J. Environ. Res. Public Health 2022, 19(3), 1101; https://doi.org/10.3390/ijerph19031101 - 19 Jan 2022
Cited by 13 | Viewed by 4710
Abstract
The double burden of HIV/AIDS and tuberculosis (TB), coupled with endemic and problematic food insecurity in Africa, can interact to negatively impact health outcomes, creating a syndemic. For people living with HIV/AIDS (PWH), food insecurity is a significant risk factor for acquiring TB [...] Read more.
The double burden of HIV/AIDS and tuberculosis (TB), coupled with endemic and problematic food insecurity in Africa, can interact to negatively impact health outcomes, creating a syndemic. For people living with HIV/AIDS (PWH), food insecurity is a significant risk factor for acquiring TB due to the strong nutritional influences and co-occurring contextual barriers. We aim to synthesize evidence on the syndemic relationship between HIV/AIDS and TB co-infection and food insecurity in Africa. We conducted a scoping review of studies in Africa that included co-infected adults and children, with evidence of food insecurity, characterized by insufficient to lack of access to macronutrients. We sourced information from major public health databases. Qualitative, narrative analysis was used to synthesize the data. Of 1072 articles screened, 18 articles discussed the syndemic effect of HIV/AIDS and TB co-infection and food insecurity. Reporting of food insecurity was inconsistent, however, five studies estimated it using a validated scale. Food insecure co-infected adults had an average BMI of 16.5–18.5 kg/m2. Negative outcomes include death (n = 6 studies), depression (n = 1 study), treatment non-adherence, weight loss, wasting, opportunistic infections, TB-related lung diseases, lethargy. Food insecurity was a precursor to co-infection, especially with the onset/increased incidence of TB in PWH. Economic, social, and facility-level factors influenced the negative impact of food insecurity on the health of co-infected individuals. Nutritional support, economic relief, and psychosocial support minimized the harmful effects of food insecurity in HIV–TB populations. Interventions that tackle one or more components of a syndemic interaction can have beneficial effects on health outcomes and experiences of PWH with TB in Africa. Full article
(This article belongs to the Special Issue Global Economic Burden of HIV/AIDS)
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Other

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12 pages, 507 KiB  
Commentary
Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action
by Emmanuel Peprah, Bronwyn Myers, Andre-Pascal Kengne, Nasheeta Peer, Omar El-Shahawy, Temitope Ojo, Barbara Mukasa, Oliver Ezechi, Juliet Iwelunmor, Nessa Ryan, Fatoumata Sakho, John Patena and Joyce Gyamfi
Int. J. Environ. Res. Public Health 2022, 19(3), 1097; https://doi.org/10.3390/ijerph19031097 - 19 Jan 2022
Cited by 3 | Viewed by 3246
Abstract
Substance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world’s largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and [...] Read more.
Substance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world’s largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and other substance use among PWH is associated with multiple vulnerabilities comprising complex behavioral, physiological, and psychological pathways that include high-risk behaviors (e.g., sexual risk-taking), HIV disease progression, and mental health problems, all of which contribute to nonadherence to antiretroviral therapy. Physiologically, severe substance use disorders are associated with increased levels of biological markers of inflammation; these, in turn, are linked to increased mortality among PWH. The biological mechanisms that underlie the increased risk of substance use among PWH remain unclear. Moreover, the biobehavioral mechanisms by which substance use contributes to adverse health outcomes are understudied in low- and middle-income countries (LMIC). Syndemic approaches to understanding the co-occurrence of substance use and HIV have largely been limited to high-income countries. We propose a syndemic coupling conceptual model to disentangle substance use from vulnerabilities to elucidate underlying disease risk for PWH. This interventionist perspective enables assessment of biobehavioral mechanisms and identifies malleable targets of intervention. Full article
(This article belongs to the Special Issue Global Economic Burden of HIV/AIDS)
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12 pages, 568 KiB  
Commentary
An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa
by Emmanuel Peprah, Mari Armstrong-Hough, Stephanie H. Cook, Barbara Mukasa, Jacquelyn Y. Taylor, Huichun Xu, Linda Chang, Joyce Gyamfi, Nessa Ryan, Temitope Ojo, Anya Snyder, Juliet Iwelunmor, Oliver Ezechi, Conrad Iyegbe, Paul O’Reilly and Andre Pascal Kengne
Int. J. Environ. Res. Public Health 2021, 18(6), 3111; https://doi.org/10.3390/ijerph18063111 - 18 Mar 2021
Cited by 8 | Viewed by 3604
Abstract
Background: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity [...] Read more.
Background: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries. Full article
(This article belongs to the Special Issue Global Economic Burden of HIV/AIDS)
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