Abstract
IntroductionWith 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.MethodsEach 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 discussionThe 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.ConclusionsGreater 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.
Highlights
With limited funds available, meeting global health targets requires countries to both mobilize and prioritize their health spending
It is generally accepted that resource allocation decisions should be informed by, or grounded in, explicit criteria based on cost-effectiveness to maximize health benefits with the resources available [7,8,9,10,11,12,13,14,15,16,17,18,19,20]
The 23 studies included in this review were conducted in Indonesia [21] and Vietnam [22] from the East Asia and Pacific (EAP) region; Argentina [23], Colombia [24], Mexico [25], and Peru [26] from the Latin America and Caribbean (LAC) region; Armenia [27], Belarus [28], Bulgaria [29], Georgia [30], Kazakhstan [31], Kyrgyzstan [32], Macedonia [33], Moldova [34], Tajikistan [35], Ukraine [36], and Uzbekistan [37] from the Eastern Europe and Central Asia (EECA) region; Zambia [38] from the Sub-Saharan Africa (SSA) region; and Cote d’Ivoire [39], Niger [40], Senegal [41], Sudan [42], and Togo [43] from the West and Central Africa (WCA) region
Summary
With limited funds available, meeting global health targets requires countries to both mobilize and prioritize their health spending. As with any component of health budgeting, planning an HIV response can be an extremely time-consuming process To aid with this process, several different tools have been developed and employed in different contexts, including the widely used GOALS resource estimation tool, the Asian Epidemic model and the Optima HIV tool [2]. A response is described as allocatively efficient if funds are allocated across different HIV interventions and delivery modalities in the way that leads to the best possible epidemic outcomes given any relevant constraints. This is important in the current epidemiological [3] and funding [4,5] context. It is generally accepted that resource allocation decisions should be informed by, or grounded in, explicit criteria based on cost-effectiveness to maximize health benefits with the resources available [7,8,9,10,11,12,13,14,15,16,17,18,19,20]
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