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Ending AIDS in Gabon: How long will it take? How much will it cost?

The prevalence of HIV in West Africa is lower than elsewhere in Africa but Gabon has one of the highest rates of HIV in that region. Gabon has a small population and a high per capita gross domestic product making it an ideal place to carry out a programme of early treatment for HIV. The effectiveness, availability and affordability of triple combination therapy make it possible to contemplate ending AIDS deaths and HIV transmission in the short term and HIV prevalence in the long term. Here we consider what would have happened in Gabon without the development of potent anti-retroviral therapy (ART), the impact that the current roll-out of ART has had on HIV, and what might be possible if early treatment with ART becomes available to all. We fit a dynamic transmission model to trends in the adult prevalence of HIV and infer trends in incidence, mortality and the impact of ART. The availability of ART has reduced the prevalence of HIV among adults not on ART from 4.2% to 2.9%, annual incidence from 0.43% to 0.27%, and the proportion of adults dying from AIDS illnesses each year from 0.36% to 0.13% saving the lives of 2.3 thousand people in 2013 alone. The provision of ART has been highly cost effective saving the country at least $18 million up to 2013.