Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies

Andrew J Shattock,Manoela Manova,Aliya Bokazhanova,Irina Petrenko,Emiko Masaki,Shufang Zhang,Christoph Hamelmann,Robyn M Stuart,David P Wilson,Clemens Benedikt,Lolita Ganina,Cliff C Kerr,Sherrie L Kelly,Tatiana Vinichenko,Richard T Gray,Predrag Đurić

doi:10.1371/journal.pone.0169530

Abstract

BackgroundDespite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels.MethodologyWe used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure—two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment.FindingsKazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%–39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%–58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%–27%] reduction in management costs, and allocating resources optimally.SignificanceWith Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.

Highlights

Many countries are experiencing downward trends in their HIV epidemics after 10–15 years of large global investment [1,2,3,4]
Central Asia–along with Europe–experiences the highest cost of donor-funded antiretroviral drugs (ART) when procured from originator companies, and the least expensive when procured from generic manufacturers [9], highlighting the importance for countries in these regions to have access to the generic ART market
With no additional annual resources, Kazakhstan could further fully achieve the ambitious targets by: (1) securing at least a 51% [49%-56%] reduction in ART costs, (2) increasing the proportion of the total budget allocated to direct programs by reducing management costs, and (3) optimally allocating available resources across treatment and prevention programs

Summary

Introduction

Many countries are experiencing downward trends in their HIV epidemics after 10–15 years of large global investment [1,2,3,4]. Kazakhstan’s gross domestic product (GDP) per capita exceeds $12,000 USD This surpasses many countries in the Eastern Europe and Central Asia (EECA) region, and suggests Kazakhstan is in a stronger position to fund its HIV response (Fig 1). Central Asia–along with Europe–experiences the highest cost of donor-funded ART when procured from originator companies, and the least expensive when procured from generic manufacturers [9], highlighting the importance for countries in these regions to have access to the generic ART market Such high treatment costs in the future would likely hinder the attainment of Kazakhstan’s HIV targets—especially after donor withdrawal. We analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels

Methods

Results

Conclusion