Publication: The Economics of Effective AIDS Treatment : Evaluating Policy Options for Thailand
Loading...
Date
2006
ISSN
Published
2006
Author(s)
Over, Mead
Masaki, Emiko
Peerapatanapokin, Wiwat
Gold, Julian
Tangcharoensathien, Viroj
Thanprasertsuk, Sombat
Editor(s)
Abstract
The 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.
Link to Data Set
Citation
“Over, Mead; Revenga, Ana; Masaki, Emiko; Peerapatanapokin, Wiwat; Gold, Julian; Tangcharoensathien, Viroj; Thanprasertsuk, Sombat. 2006. The Economics of Effective AIDS Treatment : Evaluating Policy Options for Thailand. Health, Nutrition, and Population. © World Bank. http://hdl.handle.net/10986/7196 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Assessing the Financial Sustainability of Jamaica's HIV Program(World Bank, Washington, DC, 2013)Jamaica has made many notable achievements in the fight against HIV/AIDS, which include a robust treatment program and improved HIV prevention programs that increasingly focus on the key drivers of the HIV epidemic and which are based on evidence. These attainments have resulted in a sustained decline in the estimated incidence of HIV and in a reduction in AIDS mortality. The national response to HIV/AIDS in Jamaica is currently financed by the Government as well as by several external sources, including the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United States government. It is expected, however, that external financing will cease or be significantly reduced in the next two years. As a result, a substantial increase in domestic financing for the national HIV/AIDS response will be needed. However, public debt levels are high, and the country is feeling the repercussions of the global financial crisis, thus the availability of domestic resources is and will be very tight. Any shortfall in financing whether domestic, external or both will have serious implications for the delivery of HIV services. The Government of Jamaica requested this study so as to inform its future HIV/AIDS policy response. This study is one input in a series of actions that the Government will undertake to formulate a future sustainability plan and investment framework for the National HIV Program. This study was led and financed by the World Bank and conducted in collaboration with the Government of Jamaica and United Nations Programme on HIV/AIDS (UNAIDS). The study aimed to assess the sustainability of Jamaica's National HIV Program from a fiscal perspective. Specifically, the purpose of the study was to: 1) review current spending on HIV/AIDS and the sources of financing; 2) estimate the fiscal burden of the national HIV/AIDS response and assess the outlook for external financing of the HIV program; 3) project how the epidemic will unfold as well as what the costs would be under different potential scenarios; and 4) provide recommendations to inform policy decisions.Publication HIV/AIDS(Washington, DC, 2003-10)The epidemic spread of HIV/AIDS has been ferocious, posing a great threat, not only to public health, but to social sectors, and to development itself, while the fiscal cost of HIV/AIDS is significant as well. A set of effective prevention interventions include: changing behavior through communication; making the use of condoms, diagnosis, and treatment of sexually transmitted diseases, including counseling and testing, available and affordable; ensuring a safe blood supply; and, preventing parent-to-child transmission. In addition, countries should consider implementing programs to provide cost-effective management of common opportunistic infections. Similarly, community-based, and home-based care should be made available, in addition to traditional hospital care, particularly in countries with a generalized epidemic. Lessons convey the vital need for early action, supported by community participation, targeting the most vulnerable, and prioritizing interventions, while governments should be committed to its prevention, control, and funding. Additionally, nongovernmental organizations' participation plays a decisive role against the epidemic spread, in their capacity for social mobilization, and in reaching marginal groups.Publication Scaling up HIV Treatment for MSM in Bangkok(World Bank, Washington, DC, 2015-05-01)The HIV epidemic amongst men who have sex with men (MSM) in Bangkok is substantial. The population size of MSM in Bangkok is 120,000-250,000, with approximately one-third (33.5 percent) considered high-risk, characterized by their young age, multiple partnerships, frequent unprotected anal intercourse, and sexual activities around MSM hotspots. In metropolitan Bangkok, HIV prevalence among MSM reportedly increased from 21 percent to 28 percent between 2000 and 2012. The Thai Working Group of Estimation and Projection (2013) projected an estimate of 39,000 new HIV infections would occur in Thailand during 2012-2016, based on the AIDS Epidemic Model (AEM). MSM will account for 44 percent of these new HIV cases, and 25-30 percent of these infections will likely to occur in Bangkok. In 2011, the United Nations held a high-level meeting on HIV/AIDS where they adopted the ambitious epidemiological targets of the United Nations Political Declaration on HIV/AIDS (UNPD), to be met by 2015. Attaining these specific targets would lead to substantial progress towards ending AIDS. UNAIDS has also been prioritizing the “Getting to Zero” initiative (“Zero new HIV infections. Zero AIDS-related deaths. Zero discrimination.”). The Bangkok Metropolitan Administration (BMA) recently responded with the “Bangkok: Getting to Zero” initiative, which strategizes an increased focus on prevention amongst MSM in the city. The clinical trial, HPTN052, demonstrated a 96 percent reduction of HIV transmission among heterosexual discordant couples who received ART. “Treatment as prevention” has become an increasingly accepted strategy to prevent new infections. A cost-effectiveness analysis comparing current levels of investment in targeted HIV prevention interventions for MSM in Bangkok (including treatment), with scenarios of increased coverage, would provide evidence to shape efficient national and metropolitan strategies. A return-on-investment analysis would provide an economic rationale to finance this strategy in allocating sufficient resources to address the epidemic at the most appropriate scale. Demonstration by the study that a significant reduction in transmission (including potential elimination) are both feasible and cost effective, may galvanize global political support.Publication Curbing the HIV/AIDS Epidemic in Djibouti(World Bank, Washington, DC, 2010-10)This study outlines the initial challenge presented by the HIV/AIDS epidemic, describes Djibouti's response, reviews the results achieved and the enabling factors in curbing the spread of the epidemic, and identifies remaining challenges. Between 2002 and 2008, HIV prevalence among young pregnant women aged 15-24 was reduced from 2.7 percent to 1.9 percent and among sentinel surveillance groups from 2.5 percent to 1.9 percent. HIV prevalence among tuberculosis patients was reduced from an estimated 22 percent to 12 percent. Condom use during last intercourse outside marriage increased from 27 percent to 55 percent and reached 95 percent among sex workers. Among the general population, awareness of HIV/AIDS increased to 95 percent and knowledge about transmission and prevention rose to 50 percent. Political commitment, engagement of community and religious leaders, rigorous communication, social marketing and the provision of an integrated package of medical and social services, and donor harmonization were among the key factors that contributed to the achievement of these results. Despite these impressive results in a relatively short period, Djibouti still has to address several challenges and consolidate program gains, but most importantly, funds are being mobilized from government resources to sustain the national AIDS control program.Publication Optimizing the Allocation of Resources among HIV Prevention Interventions in Honduras(World Bank, Washington, DC, 2002-06)This paper presents a model that policymakers can use to determine the resource allocation that will prevent the maximum number of new HIV infections at any given budget level. The optimal allocation exercise was conducted in Honduras, where the epidemic is still concentrated in high-risk groups but has begun spreading into the general population. Most transmissions occur through heterosexual sex, followed by sex between men, and mother-to-child transmission. Adult prevalence is estimated at 1.4 percent. The optimization exercise involves several steps:(a) choosing population subgroups targeted for intervention; (b) estimating the proportion of each subgroup that can be reached; (c) estimating the total number of new infections expected in each subpopulation; (d) defining the set of HIV prevention interventions to be considered; (e) estimating the unit cost of each intervention; and (f) estimating the expected effectiveness of each intervention. Most of the data required to run the model has to be guesstimated or derived from the literature. To address this challenge, a group of some forty local and international experts in HIV/AIDS met in Tegucigalpa in May 2002 and arrived at the consensus estimates used in this exercise. They based their estimates on data submitted by two local epidemiologists who had conducted an extensive literature search prior to the workshop. The results from this collective exercise show that for limited HIV prevention budgets (below $500,000), condom social marketing and condom distribution prevent the maximum number of HIV infections. If the HIV prevention budget is between $750,000 and $2.5 million, then Information Education and Communication (IEC) targeted at high risk groups, HIV counseling and access to rapid testing, and an information, education and communications strategy (IEC) for the Garifunas should also be part of the country's prevention strategy. The exercise shows that some prevention interventions are unattractive even when the HIV prevention budget increases to $10 million..
Users also downloaded
Showing related downloaded files
Publication Changing the Face of the Waters : The Promise and Challenge of Sustainable Aquaculture(Washington, DC: World Bank, 2007)This study provides strategic orientations and recommendations for Bank client countries and suggests approaches for the Bank's role in a rapidly changing industry with high economic potential. It identifies priorities and options for policy adjustments, catalytic investments, and entry points for the Bank and other investors to foster environmentally friendly, wealth-creating, and sustainable aquaculture. The objectives of the study are to inform and provide guidance on sustainable aquaculture to decision makers in the international development community and in client countries of international finance institutions. The study focuses on several critical issues and challenges: 1) Harnessing the contribution of aquaculture to economic development, including poverty alleviation and wealth creation, to employment and to food security and trade, particularly for least developed countries (LDCs); 2) Building environmentally sustainable aquaculture, including the role of aquaculture in the broader suite of environmental management measures; 3) Creating the enabling conditions for sustainable aquaculture, including the governance, policy, and regulatory frameworks, and identifying the roles of the public and private sectors; and 4) Developing and transferring human and institutional capacity in governance, technologies, and business models with special reference to the application of lessons from Asia to Sub-Saharan Africa and Latin America.Publication Climate Change and Migration : Evidence from the Middle East and North Africa(Washington, DC: World Bank, 2014-07-15)Climate change is a major source of concern in the Middle East and North Africa (MENA) region, and migration is often understood as one of several strategies used by households to respond to changes in climate and environmental conditions, including extreme weather events. This study focuses on the link between climate change and migration. Most micro-level studies measure climate change either by the incidences of extreme weather events or by variation in temperature or rainfall. A few studies have found that formal and informal institutions as well as policies also affect migration. Institutions that make government more responsive to households (for example through public spending) discourage both international and domestic migration in the aftermath of extreme weather events. Migration is often an option of last resort after vulnerable rural populations attempting to cope with new and challenging circumstances have exhausted other options such as eating less, selling assets, or removing children from school. This study is based in large part on new data collected in 2011 in Algeria, Egypt, Morocco, Syria, and the Republic of Yemen. The surveys were administered by in-country partners to a randomly selected set of 800 households per country. It is also important to emphasize that neither the household survey results nor the findings from the qualitative focus groups are meant to be representative of the five countries in which the work was carried, since only a few areas were surveyed in each country. This report is organized as follows: section one gives synthesis. Section two discusses household perceptions about climate change and extreme weather events. Section three focuses on migration as a coping mechanisms and income diversification strategy. Section four examines other coping and adaptation strategies. Section five discusses perceptions about government and community programs.Publication Disease Control Priorities, Third Edition(Washington, DC: World Bank, 2016-04-06)This book focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. It also includes the transition to older childhood, in particular, the overlap and commonality with the child development volume.Publication Early Child Development, From Measurement to Action : A priority for Growth and Equity(Washington, DC: World Bank, 2007)The World Bank recently hosted a symposium on the priority of early child development (ECD) for economic growth and equity. The participants urged application of population-based tools and measures to assess the outcomes of children's early years and children's readiness for school. This study is derived from the symposium and is a valuable resource for policy makers, economists, donors, and investors, as well as researchers and practitioners in early child development. It summarizes the current neuroscience on early child development and major longitudinal studies, the rationale and urgency for greater investment, and countries' innovative funding strategies. The report consists of 15 chapters authored by ECD experts and leaders in the field. The chapters are grouped into five main parts relating to the: business imperative and societal benefits of ECD investments; lessons from evaluation of longitudinal ECD interventions; countries' experiences in monitoring ECD interventions; innovative approaches to countries' financing of ECD initiatives; and next steps on the ECD agenda for the next 5 years. A theme highlighted at the symposium and enlarged upon here is the urgent need for evidence- and population-based instruments and measures to monitor, evaluate, and compare ECD interventions over time and across settings.Publication Making Monitoring and Evaluation Systems Work : A Capacity Development Toolkit(World Bank, 2009)There are constant and growing pressures on governments and organizations around the world to be more responsive to demands from internal and external stakeholders for good governance, accountability and transparency, greater development effectiveness and delivery of tangible results. Governments, parliaments, citizens, the private sector, non-governmental organizations (NGOs), civil society, international organizations, and donors are all among stakeholders interested in better performance. As demands for greater accountability and results have grown, there is an accompanying need for useful and useable results-based monitoring and evaluation systems to support the management of policies, programs, and projects. Governments and other organizations have many different kinds of tracking systems as part of their management toolkits: good human resource systems, financial systems, and accountability systems. They also need good feedback systems. A results-based monitoring and evaluation (M&E) system is essentially such a feedback system; it is a management tool to measure and evaluate outcomes, providing information for governance and decision making. Many management systems have been missing a feedback component to enable them to track the consequences of actions. Building an M&E system gives decision-makers an additional management tool by providing feedback on performance as a basis for future improvement.