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

Resource requirements to fight HIV/AIDS in Latin America and the Caribbean.

OBJECTIVES: Economists and epidemiologists from 10 countries in Latin America and the Caribbean (LAC) reviewed the methods used to develop estimates for resource requirements to address HIV/AIDS prevention and care in low- and middle-income countries. METHODS: They applied their country-specific knowledge to re-estimate the costs, coverage, and capacity of their health and education systems to expand HIV/AIDS interventions by 2005. A discrepancy of 173 million US dollars exists between the model estimates and those of country specialists. RESULTS: The most important difference between the model estimates and those of country specialists was in the estimated future price of highly active antiretroviral therapy. To a large extent, the estimates of the model reflect the efficiency gains that could result from purchasing arrangements that lead LAC countries to lower prices for antiretroviral drugs. CONCLUSION: This preliminary exercise with 10 LAC countries confirmed the validity of the use of these estimates as tools at the international level, given current data limitations, both to guide the allocation of resources across diseases and countries, and for advocacy and resource mobilization. In addition, with the country revisions, these estimates have also been shown to be key tools for country-level strategic planning

Optimizing maternal, newborn, and child health outcomes through use of multidisciplinary \u27IMPROVE\u27 teams in Lesotho: Costing component

This study builds on the USAID-funded prevention of mother-to-child transmission service delivery program (IMPROVE) already being implemented by Elizabeth Glaser Pediatric AIDS Foundation in Lesotho. Rather than designing a suite of entirely new services and delivery platforms, the intervention (conducted under Project SOAR) focused on improving existing services and strengthening the connection between facility- and community-based care. This brief describes the approach and key quantitative findings of the costing component of the IMPROVE intervention from the service provider perspective

Evaluating the Cost-Effectiveness of Pre-Exposure Prophylaxis (PrEP) and Its Impact on HIV-1 Transmission in South Africa

The original publication is available at http:/www.plosone.orgBackground: Mathematical modelers have given little attention to the question of how pre-exposure prophylaxis (PrEP) may impact on a generalized national HIV epidemic and its cost-effectiveness, in the context of control strategies such as condom use promotion and expanding ART programs. Methodology/Principal Findings: We use an age- and gender-structured model of the generalized HIV epidemic in South Africa to investigate the potential impact of PrEP in averting new infections. The model utilizes age-structured mortality, fertility, partnership and condom use data to model the spread of HIV and the shift of peak prevalence to older age groups. The model shows that universal PrEP coverage would have to be impractically high to have a significant effect on incidence reduction while ART coverage expands. PrEP targeted to 15-35-year-old women would avert 10%-25% (resp. 13%-28%) of infections in this group and 5%-12% (resp. 7%-16%) of all infections in the period 2014-2025 if baseline incidence is 0.5% per year at 2025 (resp. 0.8% per year at 2025). The cost would be $12,500-$20,000 per infection averted, depending on the level of ART coverage and baseline incidence. An optimistic scenario of 30%-60% PrEP coverage, efficacy of at least 90%, no behavior change among PrEP users and ART coverage less than three times its 2010 levels is required to achieve this result. Targeting PrEP to 25-35-year-old women (at highest risk of infection) improves impact and cost-effectiveness marginally. Relatively low levels of condom substitution (e.g., 30%) do not nullify the efficacy of PrEP, but reduces cost-effectiveness by 35%-40%. Conclusions/Significance: PrEP can avert as many as 30% of new infections in targeted age groups of women at highest risk of infection. The cost-effectiveness of PrEP relative to ART decreases rapidly as ART coverage increases beyond three times its coverage in 2010, after which the ART program would provide coverage to more than 65% of HIV+ individuals. To have a high relative cost-effective impact on reducing infections in generalized epidemics, PrEP must utilize a window of opportunity until ART has been scaled up beyond this level. © 2010 Pretorius et al.Publishers' Versio

Application of the Breakthrough RESEARCH social and behavior change costing guidelines to the RISE II Project in Niger

Breakthrough RESEARCH drafted its Guidelines for Costing Social and Behavior Change Health Interventions, in consultation with affiliate Breakthrough ACTION and other programmers, to promote quality social and behavior change program costing studies for a range of uses including budgeting, planning, economic evaluation, and advocacy. In March 2020, Breakthrough RESEARCH began applying the Guidelines to the Resilience in the Sahel (RISE) II program in Niger for a cost-effectiveness analysis through 2022. This report shares findings from application of the Breakthrough Costing Guidelines and provides an example and guidance for social and behavior change researchers and implementers on how these guidelines can be applied to other case study applications

Guidelines for costing of social and behavior change health interventions

These Guidelines for Costing of Social and Behavior Change Health Interventions (SBC Costing Guidelines) provide a framework for estimating the cost of interventions for social and behavior change, which seek to change health behaviors by addressing factors such as knowledge, attitudes, and social norms

The cost and impact of male circumcision on HIV/AIDS in Botswana

The HIV/AIDS epidemic continues to be a major issue facing Botswana, with overall adult HIV prevalence estimated to be 25.7 percent in 2007. This paper estimates the cost and impact of the draft Ministry of Health male circumcision strategy using the UNAIDS/WHO Decision-Makers' Programme Planning Tool (DMPPT). Demographic data and HIV prevalence estimates from the recent National AIDS Coordinating Agency estimations are used as input to the DMPPT to estimate the impact of scaling-up male circumcision on the HIV/AIDS epidemic. These data are supplemented by programmatic information from the draft Botswana National Strategy for Safe Male Circumcision, including information on unit cost and program goals. Alternative scenarios were developed in consultation with stakeholders. Results suggest that scaling-up adult and neonatal circumcision to reach 80% coverage by 2012 would result in averting almost 70,000 new HIV infections through 2025, at a total net cost of US$47 million across that same period. This results in an average cost per HIV infection averted of US$689. Changing the target year to 2015 and the scale-up pattern to a linear pattern results in a more evenly-distributed number of MCs required, and averts approximately 60,000 new HIV infections through 2025. Other scenarios explored include the effect of risk compensation and the impact of increasing coverage of general prevention interventions. Scaling-up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly; program design elements such as feasible patterns of scale-up and inclusion of counselling are important in evaluating the overall success of the program

The business case for investing in social and behavior change for family planning

Although the development field generally considers social and behavior change interventions essential parts of quality health programs, lack of synthesized information on costs and effectiveness means that decision-makers under-appreciate and under-fund social and behavior change efforts. This business case uses evidence to answer questions about the effectiveness, cost, cost-effectiveness, and return on investment from social and behavior change efforts. To develop this family planning social and behavior change business case, nearly 200 studies were evaluated. All USAID strategic priorities for global health—preventing child and maternal deaths, controlling the HIV/AIDS epidemic, and combating infectious diseases—employ social and behavior change approaches to varying degrees. This is the first in a planned series of complementary, health area-specific business cases