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He S, Dong W, Fairley CK, Li Z, Wei Y, Lai H, Li R, Lu P, Shen M, Wu Z, Zhang L. Optimizing health resource allocation for improving timely HIV diagnosis in China. J Int AIDS Soc 2024; 27:e26221. [PMID: 38444111 PMCID: PMC10935715 DOI: 10.1002/jia2.26221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION The Joint United Nations Programme on HIV/AIDS (UNAIDS) updated the 95-95-95 targets for the HIV endgame in 2030. To achieve the first target in a timely manner, we investigate the optimized strategy of resource allocation to maximize timely HIV diagnosis in 14 populations in China. METHODS We developed a mathematical model by integrating epidemiological, demographical and behavioural data from 12 high-risk and two general populations to evaluate the impact of various resource allocation strategies of HIV testing on HIV incidence in China. We identified the optimized allocation strategy that maximizes the number of HIV diagnoses at an estimated total spending on HIV tests in China and calculated the per-capita cost of new HIV case detection. RESULTS We estimated that 144,795 new HIV cases may occur annually in 14 populations in China, with a total annual spending of US$2.8 billion on HIV testing. The largest proportion of spending was allocated to general males (44.0%), followed by general females (42.6%) and pregnant women (5.1%). Despite this allocation strategy, only 45.5% (65,867/144,795, timely diagnosis rate) of annual new infections were diagnosed within a year of acquisition, with a cost of $42,852 required for each new HIV case detection. By optimizing the allocation of HIV testing resources within the same spending amount, we found that general females received the highest proportion of spending allocation (45.1%), followed by low-risk men who have sex with men (13.9%) and pregnant women (8.4%). In contrast, the proportion of spending allocation for the general males decreased to 0.2%. With this optimized strategy, we estimated that 120,755 (83.4%) of annual new infections would be diagnosed within a year of acquisition, with the cost required for one HIV case detection reduced to $23,364/case. Further spending increases could allow for significant increases in HIV testing among lower-risk populations. CONCLUSIONS Optimizing resource allocation for HIV testing in high-risk populations would improve HIV timely diagnosis rate of new infections and reduce cost per HIV case detection.
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Affiliation(s)
- Shihao He
- China‐Australia Joint Research Center for Infectious DiseasesSchool of Public HealthXi'an Jiaotong University Health Science CenterXi'anChina
| | - Wei Dong
- National Center for AIDS/STD Control and Prevention (NCAIDS)Chinese Center for Disease Control and Prevention (China CDC)BeijingChina
| | - Christopher K. Fairley
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolFaculty of MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Zengbin Li
- China‐Australia Joint Research Center for Infectious DiseasesSchool of Public HealthXi'an Jiaotong University Health Science CenterXi'anChina
| | - Yudong Wei
- China‐Australia Joint Research Center for Infectious DiseasesSchool of Public HealthXi'an Jiaotong University Health Science CenterXi'anChina
| | - Hao Lai
- China‐Australia Joint Research Center for Infectious DiseasesSchool of Public HealthXi'an Jiaotong University Health Science CenterXi'anChina
| | - Rui Li
- China‐Australia Joint Research Center for Infectious DiseasesSchool of Public HealthXi'an Jiaotong University Health Science CenterXi'anChina
| | - Pengyi Lu
- China‐Australia Joint Research Center for Infectious DiseasesSchool of Public HealthXi'an Jiaotong University Health Science CenterXi'anChina
| | - Mingwang Shen
- China‐Australia Joint Research Center for Infectious DiseasesSchool of Public HealthXi'an Jiaotong University Health Science CenterXi'anChina
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi ProvinceXi'anChina
- The Interdisciplinary Center for Mathematics and Life SciencesSchool of Mathematics and StatisticsXi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)Ministry of EducationXi'anChina
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention (NCAIDS)Chinese Center for Disease Control and Prevention (China CDC)BeijingChina
| | - Lei Zhang
- China‐Australia Joint Research Center for Infectious DiseasesSchool of Public HealthXi'an Jiaotong University Health Science CenterXi'anChina
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolFaculty of MedicineMonash UniversityMelbourneVictoriaAustralia
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Moolla H, Phillips A, Ten Brink D, Mudimu E, Stover J, Bansi-Matharu L, Martin-Hughes R, Wulan N, Cambiano V, Smith J, Bershteyn A, Meyer-Rath G, Jamieson L, Johnson LF. A quantitative assessment of the consistency of projections from five mathematical models of the HIV epidemic in South Africa: a model comparison study. BMC Public Health 2023; 23:2119. [PMID: 37891514 PMCID: PMC10612295 DOI: 10.1186/s12889-023-16995-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Mathematical models are increasingly used to inform HIV policy and planning. Comparing estimates obtained using different mathematical models can test the robustness of estimates and highlight research gaps. As part of a larger project aiming to determine the optimal allocation of funding for HIV services, in this study we compare projections from five mathematical models of the HIV epidemic in South Africa: EMOD-HIV, Goals, HIV-Synthesis, Optima, and Thembisa. METHODS The five modelling groups produced estimates of the total population, HIV incidence, HIV prevalence, proportion of people living with HIV who are diagnosed, ART coverage, proportion of those on ART who are virally suppressed, AIDS-related deaths, total deaths, and the proportion of adult males who are circumcised. Estimates were made under a "status quo" scenario for the period 1990 to 2040. For each output variable we assessed the consistency of model estimates by calculating the coefficient of variation and examining the trend over time. RESULTS For most outputs there was significant inter-model variability between 1990 and 2005, when limited data was available for calibration, good consistency from 2005 to 2025, and increasing variability towards the end of the projection period. Estimates of HIV incidence, deaths in people living with HIV, and total deaths displayed the largest long-term variability, with standard deviations between 35 and 65% of the cross-model means. Despite this variability, all models predicted a gradual decline in HIV incidence in the long-term. Projections related to the UNAIDS 95-95-95 targets were more consistent, with the coefficients of variation below 0.1 for all groups except children. CONCLUSIONS While models produced consistent estimates for several outputs, there are areas of variability that should be investigated. This is important if projections are to be used in subsequent cost-effectiveness studies.
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Affiliation(s)
- Haroon Moolla
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa.
| | | | | | - Edinah Mudimu
- Department of Decision Sciences, University of South Africa, Pretoria, South Africa
| | | | | | | | | | | | | | - Anna Bershteyn
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Gesine Meyer-Rath
- Center for Global Health and Development, Boston University, Boston, USA
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Microbiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
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Bugalia S, Tripathi JP. Assessing potential insights of an imperfect testing strategy: Parameter estimation and practical identifiability using early COVID-19 data in India. COMMUNICATIONS IN NONLINEAR SCIENCE & NUMERICAL SIMULATION 2023; 123:107280. [PMID: 37207195 PMCID: PMC10148719 DOI: 10.1016/j.cnsns.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/27/2023] [Accepted: 04/25/2023] [Indexed: 05/21/2023]
Abstract
A deterministic model with testing of infected individuals has been proposed to investigate the potential consequences of the impact of testing strategy. The model exhibits global dynamics concerning the disease-free and a unique endemic equilibrium depending on the basic reproduction number when the recruitment of infected individuals is zero; otherwise, the model does not have a disease-free equilibrium, and disease never dies out in the community. Model parameters have been estimated using the maximum likelihood method with respect to the data of early COVID-19 outbreak in India. The practical identifiability analysis shows that the model parameters are estimated uniquely. The consequences of the testing rate for the weekly new cases of early COVID-19 data in India tell that if the testing rate is increased by 20% and 30% from its baseline value, the weekly new cases at the peak are decreased by 37.63% and 52.90%; and it also delayed the peak time by four and fourteen weeks, respectively. Similar findings are obtained for the testing efficacy that if it is increased by 12.67% from its baseline value, the weekly new cases at the peak are decreased by 59.05% and delayed the peak by 15 weeks. Therefore, a higher testing rate and efficacy reduce the disease burden by tumbling the new cases, representing a real scenario. It is also obtained that the testing rate and efficacy reduce the epidemic's severity by increasing the final size of the susceptible population. The testing rate is found more significant if testing efficacy is high. Global sensitivity analysis using partial rank correlation coefficients (PRCCs) and Latin hypercube sampling (LHS) determine the key parameters that must be targeted to worsen/contain the epidemic.
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Affiliation(s)
- Sarita Bugalia
- Department of Mathematics, Central University of Rajasthan, Bandar Sindri, Kishangarh 305817, Ajmer, Rajasthan, India
| | - Jai Prakash Tripathi
- Department of Mathematics, Central University of Rajasthan, Bandar Sindri, Kishangarh 305817, Ajmer, Rajasthan, India
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Stuart RM, Fraser-Hurt N, Shubber Z, Vu L, Cheik N, Kerr CC, Wilson DP. How to do (or not to do)… health resource allocations using constrained mathematical optimization. Health Policy Plan 2022; 38:122-128. [PMID: 36398991 PMCID: PMC9825717 DOI: 10.1093/heapol/czac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/07/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
Abstract
Despite the push towards evidence-based health policy, decisions about how to allocate health resources are all too often made on the basis of political forces or a continuation of the status quo. This results in wastage in health systems and loss of potential population health. However, if health systems are to serve people best, then they must operate efficiently and equitably, and appropriate valuation methods are needed to determine how to do this. With the advances in computing power over the past few decades, advanced mathematical optimization algorithms can now be run on personal computers and can be used to provide comprehensive, evidence-based recommendations for policymakers on how to prioritize health spending considering policy objectives, interactions of interventions, real-world system constraints and budget envelopes. Such methods provide an invaluable complement to traditional or extended cost-effectiveness analyses or league tables. In this paper, we describe how such methods work, how policymakers and programme managers can access them and implement their recommendations and how they have changed health spending in the world to date.
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Affiliation(s)
- Robyn M Stuart
- *Corresponding author. Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, København Ø 2300, Denmark. E-mail:
| | - Nicole Fraser-Hurt
- The World Bank Group, 2121 Pennsylvania Avenue NW, Washington, DC 20433, USA
| | - Zara Shubber
- The World Bank Group, 2121 Pennsylvania Avenue NW, Washington, DC 20433, USA
| | - Lung Vu
- The World Bank Group, 2121 Pennsylvania Avenue NW, Washington, DC 20433, USA
| | - Nejma Cheik
- The World Bank Group, 2121 Pennsylvania Avenue NW, Washington, DC 20433, USA
| | - Cliff C Kerr
- Institute for Disease Modeling at the Bill & Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA,School of Physics, University of Sydney, Physics Road, Sydney, New South Wales, Camperdown 2006, Australia
| | - David P Wilson
- Burnet Institute, 85 Commercial Road, Melbourne 3004, Australia,Bill & Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA
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Shahid M, Bharali I, Hecht R, Yamey G. Approaches to improving the efficiency of HIV programme investments. BMJ Glob Health 2022; 7:bmjgh-2022-010127. [PMID: 36113892 PMCID: PMC9486198 DOI: 10.1136/bmjgh-2022-010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Minahil Shahid
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ipchita Bharali
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Robert Hecht
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Allel K, Abou Jaoude GJ, Birungi C, Palmer T, Skordis J, Haghparast-Bidgoli H. Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000463. [PMID: 36962380 PMCID: PMC10022340 DOI: 10.1371/journal.pgph.0000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
HIV/AIDS remains a leading global cause of disease burden, especially in low- and middle-income countries (LMICs). In 2020, more than 80% of all people living with HIV (PLHIV) lived in LMICs. While progress has been made in extending coverage of HIV/AIDS services, only 66% of all PLHIV were virally suppressed at the end of 2020. In addition to more resources, the efficiency of spending is key to accelerating progress towards global 2030 targets for HIV/AIDs, including viral load suppression. This study aims to estimate the efficiency of HIV/AIDS spending across 78 countries. We employed a data envelopment analysis (DEA) and a truncated regression to estimate the technical efficiency of 78 countries, mostly low- and middle-income, in delivering HIV/AIDS services from 2010 to 2018. Publicly available data informed the model. We considered national HIV/AIDS spending as the DEA input, and prevention of mother to child transmission (PMTCT) and antiretroviral treatment (ART) as outputs. The model was adjusted by independent variables to account for country characteristics and investigate associations with technical efficiency. On average, there has been substantial improvement in technical efficiency over time. Spending was converted into outputs almost twice as efficiently in 2018 (81.8%; 95% CI = 77.64, 85.99) compared with 2010 (47.5%; 95% CI = 43.4, 51.6). Average technical efficiency was 66.9% between 2010 and 2018, in other words 33.1% more outputs could have been produced relative to existing levels for the same amount of spending. There is also some variation between WHO/UNAIDS regions. European and Eastern and Southern Africa regions converted spending into outputs most efficiently between 2010 and 2018. Rule of Law, Gross National Income, Human Development Index, HIV prevalence and out-of-pocket expenditures were all significantly associated with efficiency scores. The technical efficiency of HIV investments has improved over time. However, there remains scope to substantially increase HIV/AIDS spending efficiency and improve progress towards 2030 global targets for HIV/AIDS. Given that many of the most efficient countries did not meet 2020 global HIV targets, our study supports the WHO call for additional investment in HIV/AIDS prevention and control to meet the 2030 HIV/AIDS and eradication of the AIDS epidemic.
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Affiliation(s)
- Kasim Allel
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Charles Birungi
- Institute for Global Health, University College London, London, United Kingdom
- United Nations Joint Programme on HIV and AIDS (UNAIDS), Harare, Zimbabwe
| | - Tom Palmer
- Institute for Global Health, University College London, London, United Kingdom
| | - Jolene Skordis
- Institute for Global Health, University College London, London, United Kingdom
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Goscé L, Abou Jaoude GJ, Kedziora DJ, Benedikt C, Hussain A, Jarvis S, Skrahina A, Klimuk D, Hurevich H, Zhao F, Fraser-Hurt N, Cheikh N, Gorgens M, Wilson DJ, Abeysuriya R, Martin-Hughes R, Kelly SL, Roberts A, Stuart RM, Palmer T, Panovska-Griffiths J, Kerr CC, Wilson DP, Haghparast-Bidgoli H, Skordis J, Abubakar I. Optima TB: A tool to help optimally allocate tuberculosis spending. PLoS Comput Biol 2021; 17:e1009255. [PMID: 34570767 PMCID: PMC8496838 DOI: 10.1371/journal.pcbi.1009255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 10/07/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
Approximately 85% of tuberculosis (TB) related deaths occur in low- and middle-income countries where health resources are scarce. Effective priority setting is required to maximise the impact of limited budgets. The Optima TB tool has been developed to support analytical capacity and inform evidence-based priority setting processes for TB health benefits package design. This paper outlines the Optima TB framework and how it was applied in Belarus, an upper-middle income country in Eastern Europe with a relatively high burden of TB. Optima TB is a population-based disease transmission model, with programmatic cost functions and an optimisation algorithm. Modelled populations include age-differentiated general populations and higher-risk populations such as people living with HIV. Populations and prospective interventions are defined in consultation with local stakeholders. In partnership with the latter, demographic, epidemiological, programmatic, as well as cost and spending data for these populations and interventions are then collated. An optimisation analysis of TB spending was conducted in Belarus, using program objectives and constraints defined in collaboration with local stakeholders, which included experts, decision makers, funders and organisations involved in service delivery, support and technical assistance. These analyses show that it is possible to improve health impact by redistributing current TB spending in Belarus. Specifically, shifting funding from inpatient- to outpatient-focused care models, and from mass screening to active case finding strategies, could reduce TB prevalence and mortality by up to 45% and 50%, respectively, by 2035. In addition, an optimised allocation of TB spending could lead to a reduction in drug-resistant TB infections by 40% over this period. This would support progress towards national TB targets without additional financial resources. The case study in Belarus demonstrates how reallocations of spending across existing and new interventions could have a substantial impact on TB outcomes. This highlights the potential for Optima TB and similar modelling tools to support evidence-based priority setting. Tuberculosis (TB) remains a leading global cause of death and morbidity, and 85% of deaths occur in countries where resources for TB care and control are limited. Many countries cannot finance all TB interventions or technologies, which means difficult decisions on what to prioritise and publically finance. Modelling tools can help decision-makers set priorities based on evidence, in a systematic and transparent way. This study presents Optima TB, a tool that estimates which allocations of spending across interventions will most likely maximise specified objectives—such as minimising TB deaths, prevalence and incidence. In partnership with local decision-makers and stakeholders, Optima TB was applied in Belarus. Recommendations from the model findings include focussing investment on outpatient rather than inpatient care and actively finding people with TB (e.g. through contact tracing) rather than mass testing of the population. The recommended reallocations of spending could reduce TB prevalence and deaths by up to 45% and 50%, respectively, by 2035 for the same amount of spending. Key stakeholders were engaged throughout the analysis and findings and uncertainty around the results were clearly communicated with decision-makers. The timeliness of the results helped inform national dialogue on TB care reform, among other key policy discussions.
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Affiliation(s)
- Lara Goscé
- University College London, London, United Kingdom
- * E-mail:
| | | | | | - Clemens Benedikt
- World Bank, Washington, District of Columbia, United States of America
| | | | | | - Alena Skrahina
- The Republican Scientific and Practice Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Dzmitry Klimuk
- The Republican Scientific and Practice Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Henadz Hurevich
- The Republican Scientific and Practice Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Feng Zhao
- World Bank, Washington, District of Columbia, United States of America
| | | | - Nejma Cheikh
- World Bank, Washington, District of Columbia, United States of America
| | - Marelize Gorgens
- World Bank, Washington, District of Columbia, United States of America
| | - David J. Wilson
- World Bank, Washington, District of Columbia, United States of America
| | | | | | | | | | - Robyn M. Stuart
- Burnet Institute, Melbourne, Australia
- University of Copenhagen, Copenhagen, Denmark
| | - Tom Palmer
- University College London, London, United Kingdom
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Wai B, Vasarhelyi K, Rutherford AR, Buchner C, Gustafson R, Compton M, Hull M, Williams J, Barrios R. A qualitative model of the HIV care continuum in Vancouver, Canada. Health Syst (Basingstoke) 2021; 11:84-97. [DOI: 10.1080/20476965.2021.1906762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Benny Wai
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Krisztina Vasarhelyi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | | | - Chris Buchner
- Population and Public Health, Fraser Health, Surrey, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | - Miranda Compton
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jf Williams
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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Sturniolo S, Waites W, Colbourn T, Manheim D, Panovska-Griffiths J. Testing, tracing and isolation in compartmental models. PLoS Comput Biol 2021; 17:e1008633. [PMID: 33661888 PMCID: PMC7932151 DOI: 10.1371/journal.pcbi.1008633] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/14/2020] [Indexed: 01/12/2023] Open
Abstract
Existing compartmental mathematical modelling methods for epidemics, such as SEIR models, cannot accurately represent effects of contact tracing. This makes them inappropriate for evaluating testing and contact tracing strategies to contain an outbreak. An alternative used in practice is the application of agent- or individual-based models (ABM). However ABMs are complex, less well-understood and much more computationally expensive. This paper presents a new method for accurately including the effects of Testing, contact-Tracing and Isolation (TTI) strategies in standard compartmental models. We derive our method using a careful probabilistic argument to show how contact tracing at the individual level is reflected in aggregate on the population level. We show that the resultant SEIR-TTI model accurately approximates the behaviour of a mechanistic agent-based model at far less computational cost. The computational efficiency is such that it can be easily and cheaply used for exploratory modelling to quantify the required levels of testing and tracing, alone and with other interventions, to assist adaptive planning for managing disease outbreaks.
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Affiliation(s)
- Simone Sturniolo
- Scientific Computing Department, UKRI, Rutherford Appleton Laboratory, Harwell, United Kingdom
| | - William Waites
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Tim Colbourn
- UCL Institute for Global Health, London, United Kingdom
| | - David Manheim
- University of Haifa Health and Risk Communication Research Center, Haifa, Israel
| | - Jasmina Panovska-Griffiths
- UCL Institute for Global Health, London, United Kingdom
- Department of Applied Health Research, UCL, London, United Kingdom
- Wolfson Centre for Mathematical Biology and The Queen’s College, Oxford University, Oxford, United Kingdom
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Stephens JH, Surjan A. Barriers Preventing Access by Men who have Sex with Men to HIV-related health services in Southeast Asia: A Scoping Review. Glob Public Health 2020; 17:235-253. [PMID: 33317394 DOI: 10.1080/17441692.2020.1858922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of this scoping review was to identify and describe barriers experienced by men who have sex with men (MSM) when accessing HIV-related health care in Southeast Asia. A systematic search identified thirteen papers, which were full text reviewed and data extracted. An intersection of stigma and discrimination, fear and shame, cultural norms and societal expectations coalesce to influence the ability, either physically through lack of service provision or emotionally through personal restraint, of MSM to access HIV-related health services. Many of the factors continuing to drive the ongoing HIV epidemic across the Southeast Asia region have humanitarian origin - access to safe and non-discriminatory healthcare, education on sexual health, and not being persecuted for having a health condition. These must be addressed with an interdisciplinary response at local, government and regional level.
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Affiliation(s)
- Jacqueline H Stephens
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Akhilesh Surjan
- Emergency & Disaster Management, College of Indigenous Futures, Arts and Society, Charles Darwin University, Darwin, Australia
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Gomez GB, Mudzengi DL, Bozzani F, Menzies NA, Vassall A. Estimating Cost Functions for Resource Allocation Using Transmission Models: A Case Study of Tuberculosis Case Finding in South Africa. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1606-1612. [PMID: 33248516 DOI: 10.1016/j.jval.2020.08.2096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cost functions linked to transmission dynamic models are commonly used to estimate the resources required for infectious disease policies. We present a conceptual and empirical approach for estimating these functions, allowing for nonconstant marginal costs. We aim to expand on the current approach which commonly assumes linearity of cost over scale. METHODS We propose a theoretical framework adapted from the field of transport economics. We specify joint functions of production of services within a disease-specific program. We expand these functions to include qualitative insights of program expansion patterns. We present the difference in incremental total costs between an approach assuming constant unit costs and alternative approaches that assume economies of scale, scope and homogeneous or heterogeneous facility recruitment into the programme during scale-up. We illustrate the framework's application in tuberculosis, using secondary data from the literature and routine reporting systems in South Africa. RESULTS Economies of capacity and scope substantially change cost estimates over time. Cost data requirements for the proposed approach included standardized and disaggregated unit costs (for a limited number of outputs) and information on the facilities network available to the program. CONCLUSIONS The defined functional form will determine the magnitude and shape of costs when outputs and coverage are increasing. This in turn will impact resource allocation decisions. Infectious diseases modelers and economists should use transparent and empirically based cost models for analyses that inform resource allocation decisions. This framework describes a general approach for developing these models.
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Affiliation(s)
- Gabriela B Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Fiammetta Bozzani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas A Menzies
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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12
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Suraratdecha C, Stuart RM, Edwards M, Moore R, Liu N, Wilson DP, Albalak R. Costs of providing HIV care and optimal allocation of HIV resources in Guyana. PLoS One 2020; 15:e0238499. [PMID: 33119591 PMCID: PMC7595312 DOI: 10.1371/journal.pone.0238499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Great strides in responding to the HIV epidemic have led to improved access to and uptake of HIV services in Guyana, a lower-middle-income country with a generalized HIV epidemic. Despite efforts to scale up HIV treatment and adopt the test and start strategy, little is known about costs of HIV services across the care cascade. METHODS We collected cost data from the national laboratory and nine selected treatment facilities in five of the country's ten Regions, and estimated the costs associated with HIV testing and services (HTS) and antiretroviral therapy (ART) from a provider perspective from January 1, 2016 to December 31, 2016. We then used the unit costs to construct four resource allocation scenarios. In the first two scenarios, we calculated how close Guyana would currently be to its 2020 targets if the allocation of funding across programs and regions over 2017-2020 had (a) remained unchanged from latest-reported levels, or (b) been optimally distributed to minimize incidence and deaths. In the next two, we estimated the resources that would have been required to meet the 2020 targets if those resources had been distributed (a) according to latest-reported patterns, or (b) optimally to minimize incidence and deaths. RESULTS The mean cost per test was US$15 and the mean cost per person tested positive was US$796. The mean annual cost per of maintaining established adult and pediatric patients on ART were US$428 and US$410, respectively. The mean annual cost of maintaining virally suppressed patients was US$648. Cost variation across sites may suggest opportunities for improvements in efficiency, or may reflect variation in facility type and patient volume. There may also be scope for improvements in allocative efficiency; we estimated a 28% reduction in the total resources required to meet Guyana's 2020 targets if funds had been optimally distributed to minimize infections and deaths. CONCLUSIONS We provide the first estimates of costs along the HIV cascade in the Caribbean and assessed efficiencies using novel context-specific data on the costs associated with diagnostic, treatment, and viral suppression. The findings call for better targeting of services, and efficient service delivery models and resource allocation, while scaling up HIV services to maximize investment impact.
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Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robyn M. Stuart
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
- Burnet Institute, Melbourne, Australia
- * E-mail:
| | | | | | - Nadia Liu
- Ministry of Public Health, Georgetown, Guyana
| | - David P. Wilson
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
- Monash University, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Microbial Pathogenesis, University of Maryland, Baltimore, United States of America
| | - Rachel Albalak
- U.S. Centers for Disease Control and Prevention, Caribbean Region Office, Barbados, Santo Domingo, Dominican Republic
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Abstract
PURPOSE OF REVIEW The 90-90-90 targets were launched with the aim of reaching specific milestones by 2020. To support these targets, modeling has shown that additional resources are needed. This review examines what is known about current investments for HIV in low and middle-income countries, resource needs, and the potential for additional investment. RECENT FINDINGS Reaching the 90-90-90 targets would place the global community on track to end the AIDS epidemic by 2030, significantly improving health outcomes and reducing future spending needs. Recent analyses indicate, however, that funding has slowed and there is a significant gap in resources needed to reach targets. While some studies have modeled the potential for additional HIV spending based on normative and theoretical benchmarks, there are limitations to such approaches. Others have looked at the potential to increase efficiencies. Even if spending continues at recent rates, there would still be a gap of $6.4 billion in 2020. SUMMARY There is a significant gap in resources needed to reach the 90-90-90 targets by 2020. It may be possible to reduce the gap through more efficient allocation of resources. In addition, there are efforts underway to mobilize more investment. Ultimately, any gap that remains has implications for health outcomes and future spending.
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Abstract
Purpose of review To explore the comparative importance of HIV infections among key populations and their intimate partners as HIV epidemics evolve, and to review implications for guiding responses. Recent findings Even as concentrated epidemics evolve, new infections among current and former key population members and their intimate partners dominate new infections. Prevalent infections in the general population grow primarily because of key population turnover and infections among their intimate partners. In generalized epidemic settings, data and analysis on key populations are often inadequate to assess the impact of key population-focused responses, so they remain limited in coverage and under resourced. Models must incorporate downstream infections in comparing impacts of alternative responses. Summary Recognize that every epidemic is unique, moving beyond the overly simplistic concentrated/generalized epidemic paradigm that can misdirect resources. Guide HIV responses by gathering and using locally relevant data, understanding risk heterogeneity, and applying modeling at both national and sub-national levels to optimize resource allocations among different populations for greatest impact. Translate this improved understanding into clear, unequivocal advice for policymakers on where to focus for impact, breaking them free of the generalized/concentrated paradigm limiting their thinking and affecting their decisions.
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Stuart RM, Khan O, Abeysuriya R, Kryvchun T, Lysak V, Bredikhina A, Durdykulyieva N, Mykhailets V, Kaidashova E, Doroshenko O, Shubber Z, Wilson D, Zhao F, Fraser-Hurt N. Diabetes care cascade in Ukraine: an analysis of breakpoints and opportunities for improved diabetes outcomes. BMC Health Serv Res 2020; 20:409. [PMID: 32393341 PMCID: PMC7212677 DOI: 10.1186/s12913-020-05261-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Diabetes is one of the leading causes of poor health and high care costs in Ukraine. To prevent diabetes complications and alleviate the financial burden of diabetes care on patients, the Ukrainian government reimburses diabetes medication and provides glucose monitoring, but there are significant gaps in the care continuum. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine. METHODS We gathered data on the unit costs of diabetes interventions in Poltava and estimated expenditure on diabetes care. We estimated the optimal combination of facility-based and outreach screening and investigated how additional funding could best be allocated to improve glucose control outcomes. RESULTS Of the ~ 40,000 adults in diabetes care, only ~ 25% achieved sustained glucose control. Monitoring costs were higher for those who did not: by 10% for patients receiving non-pharmacological treatment, by 61% for insulin patients, and twice as high for patients prescribed oral treatment. Initiatives to improve treatment adherence (e.g. medication copayment schemes, enhanced adherence counseling) would address barriers along the care continuum and we estimate such expenditures may be recouped by reductions in patient monitoring costs. Improvements in case detection are also needed, with only around two-thirds of estimated cases having been diagnosed. Outreach screening campaigns could play a significant role: depending on how well-targeted and scalable such campaigns are, we estimate that 10-46% of all screening could be conducted via outreach, at a cost per positive patient identified of US$7.12-9.63. CONCLUSIONS Investments to improve case detection and treatment adherence are the most efficient interventions for improved diabetes control in Poltava. Quantitative tools provide essential decision support for targeting investment to close the gaps in care.
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Affiliation(s)
- Robyn Margaret Stuart
- Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, København Ø, 2300, Copenhagen, Denmark.
| | - Olga Khan
- The World Bank Group, Washington, DC, USA
| | | | | | | | | | | | | | | | | | | | | | - Feng Zhao
- The World Bank Group, Washington, DC, USA
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Stuart RM, Wilson DP. Sharing the costs of structural interventions: What can models tell us? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:102702. [PMID: 32173275 DOI: 10.1016/j.drugpo.2020.102702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/28/2020] [Accepted: 02/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The global HIV response needs to both integrate with the broader health system and tackle the structural drivers of HIV. Cross-sectoral financing arrangements in which different sectors agree to co-finance structural interventions - have been put forward as promising frameworks to address these concerns. However, co-financing arrangements remain rare for HIV, and there is no consensus on how to distribute costs. METHODS We use case studies to investigate how structural interventions can be incorporated within three quantitative decision-making frameworks. First, we consider cost-benefit analyses (CBA) using an opioid substitution therapy (OST) program in Armenia; second, we construct a theoretical example to illustrate the lessons game theory can shed on the co-financing arrangements implied by CBA; and third we consider allocative efficiency analyses using needle-syringe programs (NSPs) in Belarus. RESULTS A cross-sectoral cost-benefit analysis of OST in Armenia demonstrates that the share of that should be funded by the HIV sector depends on the willingness to pay (WTP) to avert an HIV-related DALY, the long-term cost-benefit ratio, and the HIV risk reduction from OST. For reasonable parameter values, the HIV sector's share ranges between 0-48%. However, the Shapley value--a game-theoretic solution to cost attribution that ensures each sector gains as much or more as they would from acting independently--implies that the HIV sector's share may be higher. In Belarus, we find that the HIV sector should be willing to co-finance structural interventions that would increase the maximal attainable coverage of NSPs, with the contribution again depending on the WTP to avert an HIV-related DALY. CONCLUSION Many interventions known to have cross-sectoral benefits have historically been funded from HIV budgets, but this may change in the future. The question of how to distribute the costs of structural interventions is critical, and frameworks that decision-makers use to inform resource allocations will need to take this into account.
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Affiliation(s)
- Robyn M Stuart
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark; Burnet Institute, Melbourne, Australia.
| | - David P Wilson
- Burnet Institute, Melbourne, Australia; Monash University, Melbourne, Australia; Kirby Institute, University of New South Wales, Sydney, Australia; Department of Microbial Pathogenesis, University of Maryland, Baltimore, United States
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Stuart RM, Kelly SL, Martin-Hughes R, Wilson DP. Potential health gains in West and Central Africa through savings from lower cost HIV treatment. AIDS 2020; 34:439-446. [PMID: 31996595 DOI: 10.1097/qad.0000000000002419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Prices of antiretroviral (ARV) drugs in lower income countries have decreased substantially over the past two decades, helping to facilitate greatly expanded access to antiretroviral therapy (ART). However, ART coverage in many parts of the world remains low. We investigate the extent of epidemiological benefits that might be expected if ARV drug prices decline further. DESIGN A modeling study using data from seven countries in West and Central Africa (Cameroon, Democratic Republic of the Congo, Côte d'Ivoire, Niger, Nigeria, Senegal, and Togo). METHODS We investigated how the timing of ARV cost reductions could affect the impact and compared three different possible investment strategies: reinvesting in ART, reinvesting in the HIV response according to historical allocations, and reinvesting with the aim of minimizing HIV incidence and mortality. RESULTS If ARV drug prices fell by 37% relative to 2018 levels (i.e. following continued trend declines), we calculate ART unit costs could decrease by ∼20% (holding other cost components constant). If this could be achieved by 2020 and the savings were reinvested into ART, we estimate that an additional 8% of HIV infections and 11% of HIV-related deaths could be averted over 2020-2030 across the seven countries. Slightly greater gains could be attained if funds were reinvested in ART in combination with primary prevention. Delays in the year of introduction of ARV price reductions would reduce the impact by about 1% per year. CONCLUSION ARV price reductions could free up funds that - if strategically invested - would help countries move closer toward the elimination of HIV.
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Affiliation(s)
- Robyn M Stuart
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
- Burnet Institute
| | | | | | - David P Wilson
- Burnet Institute
- Monash University, Melbourne
- Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Microbial Pathogenesis, University of Maryland, Baltimore, USA
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Kedziora DJ, Stuart RM, Pearson J, Latypov A, Dierst-Davies R, Duda M, Avaliani N, Wilson DP, Kerr CC. Optimal allocation of HIV resources among geographical regions. BMC Public Health 2019; 19:1509. [PMID: 31718603 PMCID: PMC6849208 DOI: 10.1186/s12889-019-7681-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health resources are limited, which means spending should be focused on the people, places and programs that matter most. Choosing the mix of programs to maximize a health outcome is termed allocative efficiency. Here, we extend the methodology of allocative efficiency to answer the question of how resources should be distributed among different geographic regions. METHODS We describe a novel geographical optimization algorithm, which has been implemented as an extension to the Optima HIV model. This algorithm identifies an optimal funding of services and programs across regions, such as multiple countries or multiple districts within a country. The algorithm consists of three steps: (1) calibrating the model to each region, (2) determining the optimal allocation for each region across a range of different budget levels, and (3) finding the budget level in each region that minimizes the outcome (such as reducing new HIV infections and/or HIV-related deaths), subject to the constraint of fixed total budget across all regions. As a case study, we applied this method to determine an illustrative allocation of HIV program funding across three representative oblasts (regions) in Ukraine (Mykolayiv, Poltava, and Zhytomyr) to minimize the number of new HIV infections. RESULTS Geographical optimization was found to identify solutions with better outcomes than would be possible by considering region-specific allocations alone. In the case of Ukraine, prior to optimization (i.e. with status quo spending), a total of 244,000 HIV-related disability-adjusted life years (DALYs) were estimated to occur from 2016 to 2030 across the three oblasts. With optimization within (but not between) oblasts, this was estimated to be reduced to 181,000. With geographical optimization (i.e., allowing reallocation of funds between oblasts), this was estimated to be further reduced to 173,000. CONCLUSIONS With the increasing availability of region- and even facility-level data, geographical optimization is likely to play an increasingly important role in health economic decision making. Although the largest gains are typically due to reallocating resources to the most effective interventions, especially treatment, further gains can be achieved by optimally reallocating resources between regions. Finally, the methods described here are not restricted to geographical optimization, and can be applied to other problems where competing resources need to be allocated with constraints, such as between diseases.
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Affiliation(s)
- David J. Kedziora
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Complex Systems Group, School of Physics, University of Sydney, Sydney, Australia
| | - Robyn M. Stuart
- Burnet Institute, Melbourne, Australia
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Alisher Latypov
- Deloitte Consulting LLP, The USAID HIV Reform in Action Project, Kyiv, Ukraine
| | | | - Maksym Duda
- Deloitte Consulting LLP, The USAID HIV Reform in Action Project, Kyiv, Ukraine
| | | | | | - Cliff C. Kerr
- Burnet Institute, Melbourne, Australia
- Complex Systems Group, School of Physics, University of Sydney, Sydney, Australia
- Institute for Disease Modeling, Seattle, USA
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Sustainability and Accelerating Children's HIV/AIDS Treatment (ACT) Initiative: Lessons for the Next Treatment Surge. J Acquir Immune Defic Syndr 2019; 78 Suppl 2:S142-S146. [PMID: 29994837 DOI: 10.1097/qai.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Accelerating Children's HIV/AIDS Treatment (ACT) Initiative was an ambitious joint donor initiative to increase the number of HIV-positive children and adolescents on treatment over a 2-year period from 2014 to 2016. The funding was provided by the US Government's President's Emergency Plan for AIDS Relief (PEPFAR) and the private Children's Investment Fund Foundation (CIFF). Great gains were achieved across the 9 ACT focus countries in pediatric treatment coverage. This article assesses the status of sustainability in the ACT countries after the pediatric treatment surge using PEPFAR sustainability data and a CIFF independent evaluation of sustainability. Although a focus on treatment is critical for pediatric HIV and HIV broadly, there is also a need to support the host country ability to maintain the progress gained once donor funds and initiatives transition. It uses the case of the ACT Initiative to argue that although surge activities are successful in rapidly scaling treatment results, there are concerns related to the health system's ability to maintain the progress along the full cascade. It shares important lessons for planning for and management of transition to support future donor efforts in pediatric HIV, overall HIV programming, and broader global health initiatives.
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Applying the 'no-one worse off' criterion to design Pareto efficient HIV responses in Sudan and Togo. AIDS 2019; 33:1247-1252. [PMID: 30664007 DOI: 10.1097/qad.0000000000002155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Globally, there is increased focus on getting the greatest impact from available health funding. However, the pursuit of overall welfare maximization may mean some are left worse off than before. Pareto efficiency takes welfare shifts into account by ruling out funding reallocations that worsen outcomes for any person or group. METHODS Using the Optima HIV model, studies of HIV response efficiency were conducted in Sudan in 2014 and Togo in 2015. In this article, we estimate the welfare maximizing and Pareto efficient allocations for these two national HIV budgets, using data from the original studies. RESULTS We estimate that, if the 2013 HIV budget for Sudan was annually available to 2020 but with funds reallocated according to the welfare maximizing allocation, a 36% reduction in cumulative new infections could be achieved between 2014 and 2020. We also find that this is Pareto efficient. In Togo, however, we find that it is possible to reduce overall new infections but applying the Pareto efficiency criterion means that shifts in emphases cannot occur in the HIV response without additional resources. DISCUSSION Protecting service coverage for key population groups is not necessarily equivalent to protecting health outcomes. In some cases, requiring Pareto efficiency may reduce the potential for population-wide welfare gains, but this is not always the case. CONCLUSION Pareto efficiency may be an appropriate addition to the quantitative toolset for evaluating HIV responses.
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Abou Jaoude GJ, Skordis-Worrall J, Haghparast-Bidgoli H. Measuring financial risk protection in health benefits packages: scoping review protocol to inform allocative efficiency studies. BMJ Open 2019; 9:e026554. [PMID: 31142525 PMCID: PMC6549617 DOI: 10.1136/bmjopen-2018-026554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION To progress towards Universal Health Coverage (UHC), countries will need to define a health benefits package of services free at the point of use. Financial risk protection is a core component of UHC and should therefore be considered a key dimension of health benefits packages. Allocative efficiency modelling tools can support national analytical capacity to inform an evidence-based selection of services, but none are currently able to estimate financial risk protection. A review of existing methods used to measure financial risk protection can facilitate their inclusion in modelling tools so that the latter can become more relevant to national decision making in light of UHC. METHODS AND ANALYSIS This protocol proposes to conduct a scoping review of existing methods used to measure financial risk protection and assess their potential to inform the selection of services in a health benefits package. The proposed review will follow the methodological framework developed by Arksey and O'Malley and the subsequent recommendations made by Levac et al. Several databases will be systematically searched including: (1) PubMed; (2) Scopus; (3) Web of Science and (4) Google Scholar. Grey literature will also be scanned, and the bibliography of all selected studies will be hand searched. Following the selection of studies according to defined inclusion and exclusion criteria, key characteristics will be collected from the studies using a data extraction tool. Key characteristics will include the type of method used, geographical region of focus and application to specific services or packages. The extracted data will then be charted, collated, reported and summarised using descriptive statistics, a thematic analysis and graphical presentations. ETHICS AND DISSEMINATION The scoping review proposed in this protocol does not require ethical approval. The final results will be disseminated via publication in a peer-reviewed journal, conference presentations and shared with key stakeholders.
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Granich R, Gupta S, Williams BG. HIV, 95-95-95 and the allocative efficiency fallacy: why treating everyone makes sense from a humanitarian, clinical, economic and disease control perspective. J Int AIDS Soc 2018; 21:e25191. [PMID: 30318715 PMCID: PMC6186966 DOI: 10.1002/jia2.25191] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 09/17/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Somya Gupta
- Independent Public Health ConsultantDelhiIndia
| | - Brian G Williams
- South African Centre for Epidemiological Modelling and AnalysisStellenboschSouth Africa
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Wilson DP, Gorgens M, Wilson DJ. "Optima attempts to objectively and pragmatically assist countries meet their targets most efficiently and effectively". J Int AIDS Soc 2018; 21:e25190. [PMID: 30318851 PMCID: PMC6186967 DOI: 10.1002/jia2.25190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/17/2018] [Indexed: 11/26/2022] Open
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Kelly SL, Martin-Hughes R, Stuart RM, Yap XF, Kedziora DJ, Grantham KL, Hussain SA, Reporter I, Shattock AJ, Grobicki L, Haghparast-Bidgoli H, Skordis-Worrall J, Baranczuk Z, Keiser O, Estill J, Petravic J, Gray RT, Benedikt CJ, Fraser N, Gorgens M, Wilson D, Kerr CC, Wilson DP. The global Optima HIV allocative efficiency model: targeting resources in efforts to end AIDS. Lancet HIV 2018. [PMID: 29540265 DOI: 10.1016/s2352-3018(18)30024-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND To move towards ending AIDS by 2030, HIV resources should be allocated cost-effectively. We used the Optima HIV model to estimate how global HIV resources could be retargeted for greatest epidemiological effect and how many additional new infections could be averted by 2030. METHODS We collated standard data used in country modelling exercises (including demographic, epidemiological, behavioural, programmatic, and expenditure data) from Jan 1, 2000, to Dec 31, 2015 for 44 countries, capturing 80% of people living with HIV worldwide. These data were used to parameterise separate subnational and national models within the Optima HIV framework. To estimate optimal resource allocation at subnational, national, regional, and global levels, we used an adaptive stochastic descent optimisation algorithm in combination with the epidemic models and cost functions for each programme in each country. Optimal allocation analyses were done with international HIV funds remaining the same to each country and by redistributing these funds between countries. FINDINGS Without additional funding, if countries were to optimally allocate their HIV resources from 2016 to 2030, we estimate that an additional 7·4 million (uncertainty range 3·9 million-14·0 million) new infections could be averted, representing a 26% (uncertainty range 13-50%) incidence reduction. Redistribution of international funds between countries could avert a further 1·9 million infections, which represents a 33% (uncertainty range 20-58%) incidence reduction overall. To reduce HIV incidence by 90% relative to 2010, we estimate that more than a three-fold increase of current annual funds will be necessary until 2030. The most common priorities for optimal resource reallocation are to scale up treatment and prevention programmes targeting key populations at greatest risk in each setting. Prioritisation of other HIV programmes depends on the epidemiology and cost-effectiveness of service delivery in each setting as well as resource availability. INTERPRETATION Further reductions in global HIV incidence are possible through improved targeting of international and national HIV resources. FUNDING World Bank and Australian NHMRC.
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Affiliation(s)
- Sherrie L Kelly
- Burnet Institute, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia.
| | | | - Robyn M Stuart
- Burnet Institute, Melbourne, VIC, Australia; Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Xiao F Yap
- Burnet Institute, Melbourne, VIC, Australia
| | - David J Kedziora
- Burnet Institute, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | | | | | | | | | - Laura Grobicki
- Institute for Global Health, University College London, London, UK
| | | | | | - Zofia Baranczuk
- Institute of Global Health, University of Geneva, Geneva, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Institute of Mathematics, University of Zurich, Zurich, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Janka Petravic
- Burnet Institute, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Richard T Gray
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Cliff C Kerr
- Burnet Institute, Melbourne, VIC, Australia; School of Physics, University of Sydney, Sydney, NSW, Australia
| | - David P Wilson
- Burnet Institute, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
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Getting it right when budgets are tight: Using optimal expansion pathways to prioritize responses to concentrated and mixed HIV epidemics. PLoS One 2017; 12:e0185077. [PMID: 28972975 PMCID: PMC5626425 DOI: 10.1371/journal.pone.0185077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/06/2017] [Indexed: 12/04/2022] Open
Abstract
Background Prioritizing investments across health interventions is complicated by the nonlinear relationship between intervention coverage and epidemiological outcomes. It can be difficult for countries to know which interventions to prioritize for greatest epidemiological impact, particularly when budgets are uncertain. Methods We examined four case studies of HIV epidemics in diverse settings, each with different characteristics. These case studies were based on public data available for Belarus, Peru, Togo, and Myanmar. The Optima HIV model and software package was used to estimate the optimal distribution of resources across interventions associated with a range of budget envelopes. We constructed “investment staircases”, a useful tool for understanding investment priorities. These were used to estimate the best attainable cost-effectiveness of the response at each investment level. Findings We find that when budgets are very limited, the optimal HIV response consists of a smaller number of ‘core’ interventions. As budgets increase, those core interventions should first be scaled up, and then new interventions introduced. We estimate that the cost-effectiveness of HIV programming decreases as investment levels increase, but that the overall cost-effectiveness remains below GDP per capita. Significance It is important for HIV programming to respond effectively to the overall level of funding availability. The analytic tools presented here can help to guide program planners understand the most cost-effective HIV responses and plan for an uncertain future.
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