Publication: Optimizing Investments in Kazakhstan's HIV Response
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2016-03-01
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2016-03-01
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As part of a Regional initiative, Kazakhstan conducted an Human Immunodeficiency Virus (HIV) allocative efficiency analysis in 2014 to 2015 to inform more strategic investment in HIV programs. Kazakhstan continues to experience a concentrated HIV epidemic in which the majority of new infections occurred among key populations, particularly PWID, MSM, prison inmates, FSW, and their clients. Under current conditions (constant behaviors and program coverage), new HIV infections are projected to rise by 13 percent and deaths by 32 percent. The epidemics among PWID and MSM are projected to account for 67 percent of new HIV infections from 2015 to 2020 so need to be a core focus of programs. With optimized allocations, the cost to achieve national targets (no increase in incidence and deaths from 2015 to 2020) would be US 52 million dollars per year. The cost to achieve more ambitious future HIV response targets was estimated at US 80 million dollars.In conclusion, a combination of various efficiency gains in Kazakhstan’s HIV response can halve new HIV infections and deaths, achieving ambitious national targets at no additional cost. As a first priority, ART will be essential for reducing deaths and new infections, but unit costs need to be reviewed and reduced. A second consistent finding is the continued need to provide HIV services for PWID at scale. A third consistent finding is the need to scale up programs for MSM and at least double the current low coverage levels. Additional technical efficiency analysis is worth considering to explore the concrete pathways to achieve the proposed cost reductions for ART, OST, and management costs.
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“World Bank. 2016. Optimizing Investments in Kazakhstan's HIV Response. © World Bank. http://hdl.handle.net/10986/24965 License: CC BY 3.0 IGO.”
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Publication Optimizing Investments in the National HIV Response of Mexico(World Bank, Washington, DC, 2018-03)Despite a substantial improvement in controlling new infections of HIV over the last ten years, Mexico is experiencing a low-level epidemic with approximately 180,000 people living with HIV (Spectrum, 2013), making it the fourth ranking country in Latin America with regards to the number of people with the disease (PLHIV). The objective of increasing coverage and reducing inequality in the country is reflected in the objectives of the Specific Action Program (PAE) for the national response to HIV, AIDS and STI of 2013-2018 (Secretaria de salud), which seeks to decrease the effect of HIV and STIs, implement prevention strategies and provide comprehensive care for vulnerable population groups and those living in poverty. The possibility of achieving the objectives of the PAE is closely related to the total amount of resources that Mexico can commit to fighting HIV and the way these resources are allocated. In the hopes of assisting the Government of Mexico in further strengthening its HIV investment, the authors try to answer the question How can HIV funding be optimally allocated to the combination of HIV response interventions that will yield the highest impact in the shortest period. The study found that despite the overall greater costs of treatment with ART, this is the most cost-effective program. ART not only reduces deaths but is an effective measure to prevent new infections due to the reduction of viral load to undetectable levels. As such, the most cost-effective allocation – with no additional resources of current Program funds, is to scale up treatment, by about 4 to 8 percent, to maximize ART coverage while slightly reducing overall allocations to general population prevention.This slight increase would avert 4,235 deaths and 3,371 new infections, and improve health outcomes by around 6 percent. To increase the value-for-money of existing resources, allocation efficiency would also require the strengthening of CENSIDA´s stewardship role, to ensure that the funds transferred are invested as they were initially earmarked.Publication Optimizing Investments in Bulgaria's HIV Response(World Bank, Washington, DC, 2018-03)Bulgaria has a concentrated but growing HIV epidemic, in which HIV prevalence increased among all population groups over the past decade. This increasing trend in HIV prevalence is particularly marked among men who have sex with men (MSM). For men and women who inject drugs, assuming stable behaviors and program coverage, HIV prevalence is expected to remain above 8 percent and 5 percent respectively. There is an urgent need to shift additional domestic resources towards HIV. Bulgaria was already financing 67 percent of its HIV/AIDS response in 2014 with domestic funding. However, there is an urgent need to fill resource gaps in the overall HIV budget envelope with increased domestic financing. Current annual spending will not, according to this analysis, be sufficient to realise the proposed National Strategic Plan and international targets. The budget will need to be increased to achieve these targets and the increase will need to be larger if technical and allocative efficiency gains are not made. Bulgaria's HIV response requires a shared, long-term vision for sustainable HIV financing that harnesses wider health sector reforms and emerging financing models.Publication Optimizing Investments in Mozambique's Tuberculosis Response(World Bank, Washington, DC, 2020)This allocative efficiency analysis intended to assess Mozambique's progress towards TB strategic targets, and provide decision support for TB strategy using a combined TB epidemiological component and an economic and program analysis framework (Optima TB). Input data were collected from NTP sources, the WHO, and various TB implementers. Our model indicates declining future trends in TB prevalence, incidence and related deaths. However, the case detection rate (52 percent) remains one of the biggest hurdles. Mozambique, however, could cut TB prevalence and TB deaths by 20 percent, and TB incidence by 11 percent by allocating resources optimally. Specifically, this would entail (i) doubling the rate of household contact tracing for notified cases, (ii) screening all PLHIV during their routine outpatient visits, and (iii) focusing on community outreach activities among key populations such as prisoners, cross-border miners and community health workers. In addition, scaling up ART coverage from 55 percent (current/ 2017) to 90 percent by 2035 is projected to reduce new TB cases among PLHIV by over 50 percent (in 2035). Furthermore, our analysis shows that higher levels of TB spending lead to more rapid reductions in TB incidence. However, the rates of reduction associated with large increases in expenditure (up to 200 percent of current spending levels) begin to slow in the medium term and it is unlikely that the national TB response can deliver on the 2025 milestones and 2035 End-TB targets.Publication Value for Money in Ukraine’s HIV Response(World Bank, Washington, DC, 2016-03-01)Ukraine experiences one of the most severe HIV epidemics in Europe. An HIV allocative efficiency analysis has been carried out, which revealed that there are several key opportunities to change the course of Ukraine’s HIV epidemic:Ukraine’s current HIV response already makes strategic use of available resources (around US$80 million in 2013) prioritizing Antiretroviral Therapy (ART) and prevention programs for people who inject drugs (PWID), men who have sex with men (MSM) and female sex workers (FSW). This investment, which successfully stabilized the epidemic – although at a high level – is unlikely to lead to further declines in new infections and deaths. The number of people on ART could be doubled to 130,000 (around 60 percent of all PLHIV) within the stipulated annual budget. At the time of completion of this study (mid 2015), only around 30 percent of Ukraine’s estimated 223,000 PLHIV received treatment against a global target of 81 percent by 2020. There is need to implement efficient and effective ART scale-up, achieve the national target of 118,240 PLHIV on ART by 2018, and plan for further increasing coverage to reach global targets - with a strong focus on HIV diagnosis among key populations.Continued funding for prevention programs for key populations remains critical beyond 2018.There is need for enhanced integration of HIV services with services for Tuberculosis, drug use treatment including Opioid Substitution Therapy, blood-borne viruses and sexual health.Ukraine’s HIV response requires a shared long-term vision on sustainable HIV financing and needs to harness the wider health sector reforms and emerging financing models. This policy brief is a result of a team effort involving the State Institution Ukrainian Center for Socially Dangerous Disease Control of the MOH of Ukraine and international partners. The study was part of the regional initiatives on HIV allocative efficiency analysis and funded and technically supported by the World Bank and UNAIDS. We greatly acknowledge the contributions of all the team members, stakeholders and other partners. There are major opportunities, but also major risks in relation to HIV investment decisions in Ukraine in the coming five years. While decreasing funding would lead to a marked increase in deaths, new infections and future health care costs, a smart approach to increasing HIV investment, could avert around half of the new infections and deaths up to 2030 compared to business as usual.Publication A Case Study on How Allocative Efficiency Analysis Supported by Mathematical Modelling Changed HIV Investment in Sudan(World Bank, Washington, DC, 2015-11)This brief presents a real-life example of how a group of government decision-makers, programme managers, researchers and development partners worked together to improve the allocation of HIV resources in Sudan and thereby better address the HIV objectives that the country strives to achieve. The initial modelling analysis showed that by reallocating funds towards antiretroviral treatment (ART) and prevention programmes in Sudan, 37 percent of new HIV infections could be averted with the same amount of funding. These allocations combined with additional technical efficiency gains would allow for increasing ART coverage from 6 percent in 2013 to 34 percent in 2017, and more than double programme coverage for key populations. The reallocations in the 2015 to 2017 HIV budget for the national response are projected to avert an additional 3,200 new infections and 1,100 deaths in these three years compared to initially planned allocations.The reallocations were achieved through a rigorous HIV allocative efficiency analysis and evidence-informed policy process, conducted by a multi-disciplinary team of national and international partners working for the common goal to make Sudan’s HIV response more manageable and sustainable. The case study discusses process and outcomes of this effort. It also offers some reflections on the application of mathematical modelling to strengthening decision-making of finite HIV resources, and some lessons learned about how to go ‘beyond modelling’ to application of modelled allocative efficiency improvements to improving actual budget allocations for better health outcomes.
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