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Publication(Washington, DC: World Bank, 2006) Revenga, Ana ; Over, Mead ; Masaki, Emiko ; Peerapatanapokin, Wiwat ; Gold, Julian ; Tangcharoensathien, Viroj ; Thanprasertsuk, Sombat ; Brown, Tim ; Duncombe, Chris ; Lertiendumrong, Jongkol ; Phongphit, Seri ; Tantisak, Bussaba ; Wilson, DavidThe purpose of this report is to advise the Thai government and Thai society at large about the full range of benefits, costs, and consequences that are likely to result from the decision to expand public provision of antiretroviral therapy (ART) through National Access to Antiretroviral Program for People Living with HIV/AIDS (NAPHA) and to assist with the design of implementation policies that will achieve maximum treatment benefits, while promoting prevention of HIV/AIDS and maintaining financial sustainability within Thailand. The study has several significant findings: NAPHA with first-line regimen only is the most cost-effective policy option of those studied; NAPHA with second-line therapy is still affordable and yields large benefits in terms of life-years saved; policy options to enhance adherence and to recruit patients earlier are a good public investment; public financing will help ensure equitable access; public financing can strengthen positive spillovers and can limit negative spillovers of ART; if the success of ART rollout makes people or the government complacent about prevention, future costs could rise substantially; and future government expenditures on ART, and the lives it will save are highly sensitive to negotiated agreements on the intellectual property rights for pharmaceuticals. In its current form, Thailand's NAPHA program is affordable. Under the model's assumptions, it is also cost-effective relative to the baseline scenario. Furthermore, although the two enhanced policies we suggest early recruitment through expanded voluntary counseling and testing (VCT) and improved adherence through Person living with HIV/AIDS (PHA) groups are less cost-effective, they are still a good bargain, particularly if both are enacted.
Publication(Washington, DC, 2004) Over, Mead ; Heywood, Peter ; Gold, Julian ; Gupta, Indrani ; Hira, Subhash ; Marseille, ElliotThe three policies analyzed in this document include a minimalist policy in which the government strengthens private sector delivery, an intermediate policy of providing treatment for mothers who have AIDS and their spouses, and a generous policy of providing treatment to the poorest 40 percent of all AIDS patients. In January 2004 the Indian government adopted an AIDS financing policy which contains elements of all three of the hypothetical policies analyzed in this book. This study's projections of the total financial cost of the program and of the cost-effectiveness of the three options can help the government and its partners to plan the scale-up of the existing treatment program, to optimize the mix of components in order to improve its cost-effectiveness and to design monitoring and evaluation measures which provide feedback on program performance.