The past, present and future of HIV, AIDS and resource allocation

<p>Abstract</p> <p>Background</p> <p>How should HIV and AIDS resources be allocated to achieve the greatest possible impact? This paper begins with a theoretical discussion of this issue, describing the key elements of an "evidence-based allocation strategy". While it is noted that the quality of epidemiological and economic data remains inadequate to define such an optimal strategy, there do exist tools and research which can lead countries in a way that they can make allocation decisions. Furthermore, there are clear indications that most countries are not allocating their HIV and AIDS resources in a way which is likely to achieve the greatest possible impact. For example, it is noted that neighboring countries, even when they have a similar prevalence of HIV, nonetheless often allocate their resources in radically different ways.</p> <p>These differing allocation patterns appear to be attributable to a number of different issues, including a lack of data, contradictory results in existing data, a need for overemphasizing a multisectoral response, a lack of political will, a general inefficiency in the use of resources when they do get allocated, poor planning and a lack of control over the way resources get allocated.</p> <p>Methods</p> <p>There are a number of tools currently available which can improve the resource-allocation process. Tools such as the Resource Needs Model (RNM) can provide policymakers with a clearer idea of resource requirements, whereas other tools such as Goals and the Allocation by Cost-Effectiveness (ABCE) models can provide countries with a clearer vision of how they might reallocate funds.</p> <p>Results</p> <p>Examples from nine different countries provide information about how policymakers are trying to make their resource-allocation strategies more "evidence based". By identifying the challenges and successes of these nine countries in making more informed allocation decisions, it is hoped that future resource-allocation decisions for all countries can be improved.</p> <p>Conclusion</p> <p>We discuss the future of resource allocation, noting the types of additional data which will be required and the improvements in existing tools which could be made.</p

Assessment of Agricultural Mechanics Safety Instruction Conducted at Agricultural Teacher Education Programs Across the United States

Agricultural Educatio

Assessment of Community Relations Activities Used by Oklahoma Vocational Agriculture Teachers

Agricultural Educatio

Private sector costing of voluntary medical male circumcision in South Africa

In 2010, after voluntary medical male circumcision (VMMC) had been shown to be one of the most cost-effective strategies for preventing HIV infections, South Africa initiated a VMMC program with an ambitious target of performing 4.3 million circumcisions by 2016. However, because of a gap in knowledge concerning the overall cost of scaling up services, the South African National Department of Health requested that Project SOAR—Supporting Operational AIDS Research—conduct a private-sector costing of providing VMMC services in South Africa. The findings presented in this report provide a detailed investigation, through a comprehensive bottom-up approach, of the costs to private providers in offering VMMC to clients. Results from this study could inform discussion with private insurance providers in South Africa about standardization of VMMC tariffs. It also provides a strong rationale for reimbursing private sector providers for circumcisions of uninsured clients

Confirming the impact of HIV/AIDS epidemics on household vulnerability in Asia: the case of Cambodia.

OBJECTIVES: This study explores the effects of HIV and AIDS on household economics and the social wellbeing of children in HIV-affected families in Cambodia. METHODS: A purposive sample of parents living with HIV and their children was selected from networks of people living with HIV. 'Nearest-neighbour' households served as the comparison group. Interviews were conducted with the parent and at least one child or adolescent in each household between October 2003 and January 2004. The urban/rural sample included 1000 households, 1000 adults, and 1443 children aged 6-17 years, inclusive, and was drawn from Phnom Penh, Battambang and Takeo provinces. RESULTS: Despite similar overall expenditures, HIV-affected households incurred proportionately larger expenditures on medical care and funerals. Income among case households was lower than comparison households. HIV-affected households were more likely to sell off assets, borrow from family members, take out loans, and ration medical care and food for children. Children in HIV-affected households reported eating fewer meals in a day, increased frequency of hunger, and increased household and employment responsibilities compared with comparison children. School enrollment rates were similar between pairs of households. CONCLUSION: The results add to growing evidence that HIV and AIDS contribute to increased vulnerability to poverty and increased burdens on families and children. This study corroborates findings from previous studies in Asia, while providing country-specific information to stakeholders in Cambodia. At this stage in the epidemic, policy makers should focus on implementing and evaluating mitigation interventions

Voluntary Medical Male Circumcision: A Qualitative Study Exploring the Challenges of Costing Demand Creation in Eastern and Southern Africa

BACKGROUND: This paper proposes an approach to estimating the costs of demand creation for voluntary medical male circumcision (VMMC) scale-up in 13 countries of eastern and southern Africa. It addresses two key questions: (1) what are the elements of a standardized package for demand creation? And (2) what challenges exist and must be taken into account in estimating the costs of demand creation? METHODS AND FINDINGS: We conducted a key informant study on VMMC demand creation using purposive sampling to recruit seven people who provide technical assistance to government programs and manage budgets for VMMC demand creation. Key informants provided their views on the important elements of VMMC demand creation and the most effective funding allocations across different types of communication approaches (e.g., mass media, small media, outreach/mobilization). The key finding was the wide range of views, suggesting that a standard package of core demand creation elements would not be universally applicable. This underscored the importance of tailoring demand creation strategies and estimates to specific country contexts before estimating costs. The key informant interviews, supplemented by the researchers' field experience, identified these issues to be addressed in future costing exercises: variations in the cost of VMMC demand creation activities by country and program, decisions about the quality and comprehensiveness of programming, and lack of data on critical elements needed to "trigger the decision" among eligible men. CONCLUSIONS: Based on this study's findings, we propose a seven-step methodological approach to estimate the cost of VMMC scale-up in a priority country, based on our key assumptions. However, further work is needed to better understand core components of a demand creation package and how to cost them. Notwithstanding the methodological challenges, estimating the cost of demand creation remains an essential element in deriving estimates of the total costs for VMMC scale-up in eastern and southern Africa

Assessing the feasibility, acceptability, and costs of diagnosing HIV at birth in Lesotho and Rwanda

Infant HIV diagnosis as early as possible in a child’s life followed by immediate antiretroviral treatment (ART) could stem the progressive rise in infant mortality among HIV-positive infants, particularly as several studies have suggested that an increased proportion of perinatal infections may occur in utero when maternal ART is received during pregnancy. This Project SOAR study leveraged two existing cohort studies to address some critical questions related to very early infant diagnosis. The objective was to determine the feasibility, acceptability, and costs associated with the addition of birth HIV testing to the routine testing algorithm for infants born to HIV-positive women. Findings will contribute to the global guidance on whether current early infant diagnosis guidelines should be reconsidered to add birth HIV testing as standard of care

Voluntary Medical Male Circumcision: Logistics, Commodities, and Waste Management Requirements for Scale-Up of Services

Dianna Edgil and colleagues evaluate the supply chain and waste management costs needed to deliver mobile medical male circumcision services to 152,000 men in Swaziland, finding that per-procedure costs almost double when these factors are taken into account

Estimating the costs and perceived benefits of oral pre-exposure prophylaxis (PrEP) delivery in ten counties of Kenya: a costing and a contingent valuation study

BackgroundKenya included oral PrEP in the national guidelines as part of combination HIV prevention, and subsequently began providing PrEP to individuals who are at elevated risk of HIV infection in 2017. However, as scale-up continued, there was a recognized gap in knowledge on the cost of delivering oral PrEP. This gap limited the ability of the Government of Kenya to budget for its PrEP scale-up and to evaluate PrEP relative to other HIV prevention strategies. The following study calculated the actual costs of oral PrEP scale-up as it was being delivered in ten counties in Kenya. This costing also allowed for a comparison of various models of service delivery in different geographic regions from the perspective of service providers in Kenya. In addition, the analysis was also conducted to understand factors that indicate why some individuals place a greater value on PrEP than others, using a contingent valuation technique.MethodsData collection was completed between November 2017 and September 2018. Costing data was collected from 44 Kenyan health facilities, consisting of 23 public facilities, 5 private facilities and 16 drop-in centers (DICEs) through a cross-sectional survey in ten counties. Financial and programmatic data were collected from financial and asset records and through interviewer administered questionnaires. The costs associated with PrEP provision were calculated using an ingredients-based costing approach which involved identification and costing of all the economic inputs (both direct and indirect) used in PrEP service delivery. In addition, a contingent valuation study was conducted at the same 44 facilities to understand factors that reveal why some individuals place a greater value on PrEP than others. Interviews were conducted with 2,258 individuals (1,940 current PrEP clients and 318 non-PrEP clients). A contingent valuation method using a “payment card approach” was used to determine the maximum willingness to pay (WTP) of respondents regarding obtaining access to oral PrEP services.ResultsThe weighted cost of providing PrEP was $253 per person year, ranging from$217 at health centers to $283 at dispensaries. Drop-in centers (DICEs), which served about two-thirds of the client volume at surveyed facilities, had a unit cost of$276. The unit cost was highest for facilities targeting MSM ($355), while it was lowest for those targeting FSW ($248). The unit cost for facilities targeting AGYW was $323 per person year. The largest percentage of costs were attributable to personnel (58.5$2 per month (mean was $4.07 per month). This covers only one-third of the monthly cost of the medication (approximately$6 per month) and less than 10% of the full cost of delivering PrEP ($21 per month). A sizable proportion of current clients (27%) were unwilling to pay anything for PrEP. Certain populations put a higher value on PrEP services, including: FSW and MSM, Muslims, individuals with higher education, persons between the ages of 20 and 35, and households with a higher income and expenditures.DiscussionThis is the most recent and comprehensive study on the cost of PrEP delivery in Kenya. These results will be used in determining resource requirements and for resource mobilization to facilitate sustainable PrEP scale-up in Kenya and beyond. This contingent valuation study does have important implications for Kenya's PrEP program. First, it indicates that some populations are more motivated to adopt oral PrEP, as indicated by their higher WTP for the service. MSM and FSW, for example, placed a higher value on PrEP than AGYW. Higher educated individuals, in turn, put a much higher value on PrEP than those with less education (which may also reflect the higher “ability to pay” among those with more education). This suggests that any attempt to increase demand or improve PrEP continuation should consider these differences in client populations. Cost recovery from existing PrEP clients would have potentially negative consequences for uptake and continuation

FR1.3: Coping with Stressors along the Cassava Value Chain in Nigeria: Evidence to Strengthen Gender-Responsive Breeding and Inform Resilience

This study investigates gender perspectives on climate change (CC) and conflict stressors surrounding the cassava value-chain (VC) in Nigeria. Research Question(s): A State of Knowledge review identified the need to inquire into coping strategies and the preferred stressor-related cassava traits by specifically asking, "In what ways do gender roles and norms influence these". Methodology: Data elicited from 187 cassava farmers, 15 Key Informants and 63 VC Focus Group participants were analysed using descriptive and inferential statistics. Key findings: The study validates CC as a key factor in increased conflicts. Farmer-herder clashes, communal clashes and land disputes exacerbate the emergence of farm burning, theft and influence the kind of cassava food product made. This shapes stressor-related trait preferences like ‘early re-emergence of leaves after grazing', ‘short stem', ‘ratooning potential', and ‘stem-longevity' among men and women farmers and ‘multi-purpose suitability of roots' among processors/marketers mainly women. Coping mechanisms include relocating farms, migration and fragmented farming among men, and choice of food with less processing steps, backyard farming, forcing daughter's premature marriage and dependence on remittances from husbands among women. Resilience capacity is generally low, but men have a higher overall resilience capacity (t = 5.45) and level of access to assets (t = 6.698) which facilitate coping strategies like ‘relocating farms', migration and ‘fragmented farming'. Relevance and Implication of findings: Results present gendered coping strategies, corresponding stressor-related traits, as additional aspects important when evaluating the gender impact of breeding strategies concerning the positive benefits for, and possible harm to cassava users and especially women engaged in the cassava VC activities