How should HIV resources be allocated? Lessons learnt from applying Optima HIV in 23 countries.

Autor: Stuart RM; Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark.; Burnet Institute, Melbourne, VIC, Australia., Grobicki L; Institute for Global Health, University College London, London, UK., Haghparast-Bidgoli H; Institute for Global Health, University College London, London, UK., Panovska-Griffiths J; Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK.; Department of Applied Health Research, University College London, London, UK.; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK., Skordis J; Institute for Global Health, University College London, London, UK., Keiser O; Institute of Global Health, University of Geneva, Geneva, Switzerland.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Estill J; Institute of Global Health, University of Geneva, Geneva, Switzerland.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland., Baranczuk Z; Institute of Global Health, University of Geneva, Geneva, Switzerland.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Institute of Mathematics, University of Zurich, Zurich, Switzerland., Kelly SL; Burnet Institute, Melbourne, VIC, Australia.; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia., Reporter I; Burnet Institute, Melbourne, VIC, Australia., Kedziora DJ; Burnet Institute, Melbourne, VIC, Australia.; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.; School of Physics, University of Sydney, Sydney, NSW, Australia., Shattock AJ; The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia., Petravic J; Burnet Institute, Melbourne, VIC, Australia., Hussain SA; Burnet Institute, Melbourne, VIC, Australia., Grantham KL; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia., Gray RT; The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia., Yap XF; Burnet Institute, Melbourne, VIC, Australia., Martin-Hughes R; Burnet Institute, Melbourne, VIC, Australia., Benedikt CJ; The World Bank Group, Washington, DC, USA., Fraser-Hurt N; The World Bank Group, Washington, DC, USA., Masaki E; The World Bank Group, Washington, DC, USA., Wilson DJ; The World Bank Group, Washington, DC, USA., Gorgens M; The World Bank Group, Washington, DC, USA., Mziray E; The World Bank Group, Washington, DC, USA., Cheikh N; The World Bank Group, Washington, DC, USA., Shubber Z; The World Bank Group, Washington, DC, USA., Kerr CC; Burnet Institute, Melbourne, VIC, Australia.; School of Physics, University of Sydney, Sydney, NSW, Australia., Wilson DP; Burnet Institute, Melbourne, VIC, Australia.; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2018 Apr; Vol. 21 (4), pp. e25097.
DOI: 10.1002/jia2.25097
Abstrakt: Introduction: With limited funds available, meeting global health targets requires countries to both mobilize and prioritize their health spending. Within this context, countries have recognized the importance of allocating funds for HIV as efficiently as possible to maximize impact. Over the past six years, the governments of 23 countries in Africa, Asia, Eastern Europe and Latin America have used the Optima HIV tool to estimate the optimal allocation of HIV resources.
Methods: Each study commenced with a request by the national government for technical assistance in conducting an HIV allocative efficiency study using Optima HIV. Each study team validated the required data, calibrated the Optima HIV epidemic model to produce HIV epidemic projections, agreed on cost functions for interventions, and used the model to calculate the optimal allocation of available funds to best address national strategic plan targets. From a review and analysis of these 23 country studies, we extract common themes around the optimal allocation of HIV funding in different epidemiological contexts.
Results and Discussion: The optimal distribution of HIV resources depends on the amount of funding available and the characteristics of each country's epidemic, response and targets. Universally, the modelling results indicated that scaling up treatment coverage is an efficient use of resources. There is scope for efficiency gains by targeting the HIV response towards the populations and geographical regions where HIV incidence is highest. Across a range of countries, the model results indicate that a more efficient allocation of HIV resources could reduce cumulative new HIV infections by an average of 18% over the years to 2020 and 25% over the years to 2030, along with an approximately 25% reduction in deaths for both timelines. However, in most countries this would still not be sufficient to meet the targets of the national strategic plan, with modelling results indicating that budget increases of up to 185% would be required.
Conclusions: Greater epidemiological impact would be possible through better targeting of existing resources, but additional resources would still be required to meet targets. Allocative efficiency models have proven valuable in improving the HIV planning and budgeting process.
(© 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.)
Databáze: MEDLINE
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