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Getting it right when budgets are tight: Using optimal expansion pathways to prioritize responses to concentrated and mixed HIV epidemics.
Stuart, Robyn M; Kerr, Cliff C; Haghparast-Bidgoli, Hassan; Estill, Janne; Grobicki, Laura; Baranczuk, Zofia; Prieto, Lorena; Montañez, Vilma; Reporter, Iyanoosh; Gray, Richard T; Skordis-Worrall, Jolene; Keiser, Olivia; Cheikh, Nejma; Boonto, Krittayawan; Osornprasop, Sutayut; Lavadenz, Fernando; Benedikt, Clemens J; Martin-Hughes, Rowan; Hussain, S Azfar; Kelly, Sherrie L; Kedziora, David J; Wilson, David P.
Afiliação
  • Stuart RM; Burnet Institute, Melbourne VIC, Australia.
  • Kerr CC; Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark.
  • Haghparast-Bidgoli H; Burnet Institute, Melbourne VIC, Australia.
  • Estill J; School of Physics, University of Sydney, Sydney, Australia.
  • Grobicki L; Institute for Global Health, University College London, London, United Kingdom.
  • Baranczuk Z; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
  • Prieto L; Institute of Global Health, University of Geneva, Geneva, Switzerland.
  • Montañez V; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland.
  • Reporter I; Institute for Global Health, University College London, London, United Kingdom.
  • Gray RT; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
  • Skordis-Worrall J; Institute of Global Health, University of Geneva, Geneva, Switzerland.
  • Keiser O; Institute of Mathematics, University of Zurich, Zurich, Switzerland.
  • Cheikh N; Universidad del Pacífico, Lima, Peru.
  • Boonto K; Universidad del Pacífico, Lima, Peru.
  • Osornprasop S; Burnet Institute, Melbourne VIC, Australia.
  • Lavadenz F; The Kirby Institute, UNSW Sydney, Sydney NSW, Australia.
  • Benedikt CJ; Institute for Global Health, University College London, London, United Kingdom.
  • Martin-Hughes R; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
  • Hussain SA; Institute of Global Health, University of Geneva, Geneva, Switzerland.
  • Kelly SL; The World Bank Group, Washington DC, United States of America.
  • Kedziora DJ; UNAIDS Myanmar, Yangon, Myanmar.
  • Wilson DP; The World Bank Group, Washington DC, United States of America.
PLoS One ; 12(10): e0185077, 2017.
Article em En | MEDLINE | ID: mdl-28972975
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.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Orçamentos / Infecções por HIV / Prioridades em Saúde Tipo de estudo: Health_economic_evaluation / Prognostic_studies Limite: Humans Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Austrália

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Orçamentos / Infecções por HIV / Prioridades em Saúde Tipo de estudo: Health_economic_evaluation / Prognostic_studies Limite: Humans Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Austrália