Pakistan Case Study
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2012–2015, but more can and should be done, as Pakistani experts suggested (Pakistan Harm Reduction Technical Advisory Committee 2012). Comparing Status Quo to the Baseline scenario, the availability of proportionate access for PWID in ART scale-up has little effect on infections in the group due to the small scale of the ART intervention overall. In our model, the coverage among PWID eligible for ART at the current threshold in Pakistan of CD4 t-cells below 350 cells per mm3 rises from between 4 and 5 percent in the Status Quo scenario to 6 percent in the Baseline scenario. This also reflects the modeling of other PLWHA eligible for ART, from non-PWID risk groups, getting their share of the intervention. The rise in coverage for ART among PWID is insufficient to create major change in the incidence in the group. Pakistan needs to scale up ART further. However, we find that with the expansion in the coverage of three of the four key PWID interventions—HCT for PWID, NSP, and MAT—new HIV infections among PWID decline sharply (Figure 4.4). Figure 4.4 New HIV infections among PWID in Pakistan—comparison across modeled scenarios
5,500
New HIV infections
5,000 4,500
Status quo
4,000
Expansion conservative
3,500
Baseline
3,000
Expansion optimistic
2,500 2,000
2011
2012
2013 Year
2014
2015
Source: Authors’ calculations.
While Figure 4.4 suggests ART scale-up alone is not effective for reduction in incidence among PWID at the current scale, it does lead to modest reductions in incidence more broadly across all risk groups in Goals, as shown in Table 4.4 (Baseline compared to Status Quo). In 2015, Pakistan’s current