Abstract
BackgroundMathematical modeling has been applied to a range of policy-level decisions on resource allocation for HIV care and treatment. We describe the application of classic operations research (OR) techniques to address logistical and resource management challenges in HIV treatment scale-up activities in resource-limited countries.MethodsWe review and categorize several of the major logistical and operational problems encountered over the last decade in the global scale-up of HIV care and antiretroviral treatment for people with AIDS. While there are unique features of HIV care and treatment that pose significant challenges to effective modeling and service improvement, we identify several analogous OR-based solutions that have been developed in the service, industrial, and health sectors.ResultsHIV treatment scale-up includes many processes that are amenable to mathematical and simulation modeling, including forecasting future demand for services; locating and sizing facilities for maximal efficiency; and determining optimal staffing levels at clinical centers. Optimization of clinical and logistical processes through modeling may improve outcomes, but successful OR-based interventions will require contextualization of response strategies, including appreciation of both existing health care systems and limitations in local health workforces.ConclusionThe modeling techniques developed in the engineering field of operations research have wide potential application to the variety of logistical problems encountered in HIV treatment scale-up in resource-limited settings. Increasing the number of cross-disciplinary collaborations between engineering and public health will help speed the appropriate development and application of these tools.
Highlights
Mathematical modeling has been applied to a range of policy-level decisions on resource allocation for HIV care and treatment
In the last ten years, the campaign to scale up HIV care and antiretroviral therapy (ART) for millions of people with AIDS living in resource-limited countries has gained substantial commitments in financing [e.g., the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the World Bank's Multi-Country AIDS Program (MAP), the United States' President's Emergency Plan for AIDS Relief (PEPFAR) program, private donors such as the Bill & Melinda Gates Foundation], operational support [e.g., Joint United Nations Programme on HIV (UNAIDS), World Health Organization (WHO)], and procurement support [e.g., the Clinton Foundation HIV/ AIDS Initiative (CHAI)]
The operational challenges include developing adequate and efficient physical infrastructures, providing long-term financial sustainability, and eliminating constraints to treatment capacity, most notably in human resources and pharmaceuticals and diagnostics supply chains. These challenges were noted in a recent review of the PEPFAR program: "The continuing challenge for the U.S Global AIDS Initiative is to simultaneously maintain the urgency and intensity that have allowed it to support a substantial expansion of HIV/AIDS services in a relatively short time while placing greater emphasis on longterm strategic planning and increasing the attention and resources directed to capacity building for sustainability [5]." Below we describe one scientific field that holds promise to help maintain the acceleration of HIV treatment scale-up: the discipline of Operations Research (OR), the applied science of maximizing the effective use of limited resources [6]
Summary
Mathematical modeling has been applied to a range of policy-level decisions on resource allocation for HIV care and treatment. While over 30 million people are living with HIV and over 2 million new infections are estimated to occur each year, HIV care and treatment has expanded significantly in this decade: it is estimated that by December 2006 more than 2 million people, or 28% of people living with HIV in low- and middle-income countries, had access to antiretroviral treatment, a substantial improvement from 2% coverage just three years earlier [1,2,3] These figures confirm the success of early efforts to scale up global HIV treatment, but serious obstacles to continued expansion remain to be addressed. The operational challenges include developing adequate and efficient physical infrastructures, providing long-term financial sustainability, and eliminating constraints to treatment capacity, most notably in human resources and pharmaceuticals and diagnostics supply chains
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