Optimizing Investments in Georgia’s HIV Response

Georgia has a concentrated but growing HIV epidemic. Over the past decade, HIV prevalence has increased among all population groups, particularly among men who have sex with men (MSM). If current conditions (behaviors and service coverage) are sustained up to 2030, the epidemic is expected to stabilize among female sex workers (FSWs). At the same time, HIV prevalence among people who inject drugs (PWID) and the clients of female sex workers (FSW) may increase, but at a slower rate than in the past. MSM account for the largest proportion of new infections and experience the highest prevalence levels of HIV (13 percent in 2012). However, prevention programs that specifically target MSM currently account for approximately only 3 percent of HIV spending. The HIV epidemic in the general population is expected to increase due largely to the increasing HIV prevalence among MSM and existing prevalence among PWID. The HIV epidemic among PWID in Georgia has stabilized due to significant and prolonged efforts to target this population. Testing key populations and their sexual partners is the most cost-effective strategy to identify those who require antiretroviral therapy (ART). Testing key populations and their sexual partners is the most cost-effective strategy to identify those who require antiretroviral therapy (ART). Opportunities exist to further optimize investments. Improvements in technical efficiency may provide additional gains.The health and economic burden of HIV in Georgia is growing. In the long term, the model predicts that HIV resource needs will increase with rising incidence and prevalence. However, the analysis estimates that optimizing current allocations by increasing spending on ART provision while sustaining investment in key populations could save approximately 224,635 dollars annually. The results also show that optimizing the allocation of current spending would lower annual spending commitments for newly infected PLHIV by approximately 15 percent. Current annual spending will not be enough to achieve National HIV Strategic Plan and international targets

The MDG Enterprise: Experiences and Thoughts from Zambia

This article outlines Zambia's uneven progress towards attaining the MDGs. The central goal of cutting poverty in half by the end of 2015 appears to be definitely out of reach, whereas the goals of universalising primary education, reversing the HIV epidemic and ensuring access to HIV treatment for all who need it have been virtually reached. The greatest progress towards MDG targets was made in areas that directly involved people as beneficiaries, where their active participation was required, and where costs were not prohibitive. Although the MDGs were incorporated as guiding principles in Zambia's national planning, they were not set within a rigorous institutionalised planning and budgetary framework. Direct pursuit of the MDGs themselves was largely absent, except for those that fell within the remit of different UN agencies. A critique of the MDG framework is that while responding to widely experienced real human needs, it seemed to do so largely from an external perspective, without sufficient ownership either at the national level of policymakers and planners or at the local level of needs for which individuals required urgent relief. Nevertheless, the MDG framework has been remarkable in the way it has focused the attention of the world on the plight of the poor and those living in less than human conditions. Arguably, this may be the most noteworthy contribution that the entire enterprise has made to human development

The Socioeconomic Determinants of HIV/AIDS Infection Rates in Lesotho, Malawi, Swaziland and Zimbabwe

This paper uses data from the Demographic and Health Survey to analyze the relationship between HIV status and the socioeconomic and demographic characteristics of adults in Lesotho, Malawi, Swaziland and Zimbabwe. We construct the HIV/AIDS risk profile of the average adult, compute the values of age, education and wealth where the estimated probability of infection assumes its highest value, and we determine the percentage of adults for which age, education and wealth are positively correlated with the probability of infection. We find that in all the four countries: (i) the probability of being HIV positive is higher for women than for men; (ii) the likelihood of infection is higher for urban residents than for rural residents; and (iii) there is an inverted-U relationship between age and HIV status. We also find that unlike gender, rural/urban residence and age, the relationship between the probability of HIV infection and wealth, education and marital status varies by country. Our results provide support for country specific and more targeted HIV policies and programs

Researching the Determinants of Vulnerability to HIV among Adolescents

Adolescents in sub-Saharan Africa are among the most vulnerable to HIV. Those who reside in households most affected by AIDS are often the most poor and socially disconnected; and many have also been orphaned by one or both parents. Many orphans and vulnerable children (OVC) and youth HIV programmes do not reach these adolescents in meaningful ways. In addition, most programmes do not address the crucial link between orphanhood status, HIV risk, and the need for social and economic support to mitigate their life circumstances. This is especially true for young females, who generally have greater social, economic and health vulnerabilities, and fewer protective assets in these environments. This article highlights research findings that identify the contribution of social capital, poverty, and orphan status to the adolescent experience in the wake of HIV/AIDS, and consequently, to better inform policies and programmes that target and attend to the needs of young people most at risk

Cash transfers for HIV prevention: considering their potential.

INTRODUCTION: Cash payments to vulnerable households and/or individuals have increasingly garnered attention as a means to reduce poverty, improve health and achieve other development-related outcomes. Recent evidence from Malawi and Tanzania suggests that cash transfers can impact HIV-related behaviours and outcomes and, therefore, could serve as an important addition to HIV prevention efforts. DISCUSSION: This article reviews the current evidence on cash transfers for HIV prevention and suggests unresolved questions for further research. Gaps include (1) understanding more about the mechanisms and pathways through which cash transfers affect HIV-related outcomes; (2) addressing key operational questions, including the potential feasibility and the costs and benefits of different models of transfers and conditionality; and (3) evaluating and enhancing the wider impacts of cash transfers on health and development. CONCLUSIONS: Ongoing and future studies should build on current findings to unpack unresolved questions and to collect additional evidence on the multiple impacts of transfers in different settings. Furthermore, in order to address questions on sustainability, cash transfer programmes need to be integrated with other sectors and programmes that address structural factors such as education and programming to promote gender equality and address HIV

Number and timing of antenatal HIV testing: Evidence from a community-based study in Northern Vietnam

<p>Abstract</p> <p>Background</p> <p>HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been scaled up to reach first level health facilities.</p> <p>Methods</p> <p>A cross-sectional community-based study was conducted among 1108 recently delivered mothers through face-to-face interviews following a structured questionnaire that focused on socio-economic characteristics, experiences of antenatal care and HIV testing.</p> <p>Results</p> <p>The prevalence of women who lacked HIV testing among the study group was 10% while more than half of the women tested had had more than two tests during pregnancy. The following factors were associated with the lack of antenatal HIV test: having two children (aOR 2.1, 95% CI 1.3-3.4), living in a remote rural area (aOR 7.8, 95% CI 3.4-17.8), late antenatal care attendance (aOR 3.6, 95% CI 1.3-10.1) and not being informed about PMTCT at their first antenatal care visits (aOR 7.4, 95% CI 2.6-21.1). Among women who had multiple tests, 80% had the second test after 36 weeks of gestation. Women who had first ANC and first HIV testing at health facilities at primary level were more likely to be tested multiple times (OR 2.9 95% CI 1.9-4.3 and OR = 4.7 95% CI 3.5-6.4), respectively.</p> <p>Conclusions</p> <p>Not having an HIV test during pregnancy was associated with poor socio-economic characteristics among the women and with not receiving information about PMTCT at the first ANC visit. Multiple testing during pregnancy prevailed; the second tests were often provided at a late stage of gestation.</p

Current status of medication adherence and infant follow up in the prevention of mother to child HIV transmission programme in Addis Ababa: a cohort study

<p>Abstract</p> <p>Background</p> <p>Prevention of mother to child HIV transmission (PMTCT) programmes have great potential to achieve virtual elimination of perinatal HIV transmission provided that PMTCT recommendations are properly followed. This study assessed mothers and infants adherence to medication regimen for PMTCT and the proportions of exposed infants who were followed up in the PMTCT programme.</p> <p>Methods</p> <p>A prospective cohort study was conducted among 282 HIV-positive mothers attending 15 health facilities in Addis Ababa, Ethiopia. Descriptive statistics, bivariate and mulitivariate logistic regression analyses were done.</p> <p>Results</p> <p>Of 282 mothers enrolled in the cohort, 232 (82%, 95% CI 77-86%) initiated medication during pregnancy, 154 (64%) initiated combined zidovudine (ZDV) prophylaxis regimen while 78 (33%) were initiated lifelong antiretroviral treatment (ART). In total, 171 (60%, 95% CI 55-66%) mothers ingested medication during labour. Of the 221 live born infants (including two sets of twins), 191 (87%, 95% CI 81-90%) ingested ZDV and single-dose nevirapine (sdNVP) at birth. Of the 219 live births (twin births were counted once), 148 (68%, 95% CI 61-73%) mother-infant pairs ingested their medication at birth. Medication ingested by mother-infant pairs at birth was significantly and independently associated with place of delivery. Mother-infant pairs attended in health facilities at birth were more likely (OR 6.7 95% CI 2.90-21.65) to ingest their medication than those who were attended at home. Overall, 189 (86%, 95% CI 80-90%) infants were brought for first pentavalent vaccine and 115 (52%, 95% CI 45-58%) for early infant diagnosis at six-weeks postpartum. Among the infants brought for early diagnosis, 71 (32%, 95% CI 26-39%) had documented HIV test results and six (8.4%) were HIV positive.</p> <p>Conclusions</p> <p>We found a progressive decline in medication adherence across the perinatal period. There is a big gap between mediation initiated during pregnancy and actually ingested by the mother-infant pairs at birth. Follow up for HIV-exposed infants seem not to be organized and is inconsistent. In order to maximize effectiveness of the PMTCT programme, the rate of institutional delivery should be increased, the quality of obstetric services should be improved and missed opportunities to exposed infant follow up should be minimized.</p

Financing equitable access to antiretroviral treatment in South Africa

<p>Abstract</p> <p>Background</p> <p>While South Africa spends approximately 7.4% of GDP on healthcare, only 43% of these funds are spent in the public system, which is tasked with the provision of care to the majority of the population including a large proportion of those in need of antiretroviral treatment (ART). South Africa is currently debating the introduction of a National Health Insurance (NHI) system. Because such a universal health system could mean increased public healthcare funding and improved access to human resources, it could improve the sustainability of ART provision. This paper considers the minimum resources that would be required to achieve the proposed universal health system and contrasts these with the costs of scaled up access to ART between 2010 and 2020.</p> <p>Methods</p> <p>The costs of ART and universal coverage (UC) are assessed through multiplying unit costs, utilization and estimates of the population in need during each year of the planning cycle. Costs are from the provider’s perspective reflected in real 2007 prices.</p> <p>Results</p> <p>The annual costs of providing ART increase from US$1 billion in 2010 to US$3.6 billion in 2020. If increases in funding to public healthcare only keep pace with projected real GDP growth, then close to 30% of these resources would be required for ART by 2020. However, an increase in the public healthcare resource envelope from 3.2% to 5%-6% of GDP would be sufficient to finance both ART and other services under a universal system (if based on a largely public sector model) and the annual costs of ART would not exceed 15% of the universal health system budget.</p> <p>Conclusions</p> <p>Responding to the HIV-epidemic is one of the many challenges currently facing South Africa. Whether this response becomes a “resource for democracy” or whether it undermines social cohesiveness within poor communities and between rich and poor communities will be partially determined by the steps that are taken during the next ten years. While the introduction of a universal system will be complex, it could generate a health system responsive to the needs of all South Africans.</p