Pattern and levels of spending allocated to HIV prevention programs in low- and middle-income countries.

BACKGROUND: AIDS continues to spread at an estimated 2.6 new million infections per year, making the prevention of HIV transmission a critical public health issue. The dramatic growth in global resources for AIDS has produced a steady scale-up in treatment and care that has not been equally matched by preventive services. This paper is a detailed analysis of how countries are choosing to spend these more limited prevention funds. METHODS: We analyzed prevention spending in 69 low- and middle-income countries with a variety of epidemic types, using data from national domestic spending reports. Spending information was from public and international sources and was analyzed based on the National AIDS Spending Assessment (NASA) methods and classifications. RESULTS: Overall, prevention received 21% of HIV resources compared to 53% of funding allocated to treatment and care. Prevention relies primarily on international donors, who accounted for 65% of all prevention resources and 93% of funding in low-income countries. For the subset of 53 countries that provided detailed spending information, we found that 60% of prevention resources were spent in five areas: communication for social and behavioral change (16%), voluntary counselling and testing (14%), prevention of mother-to-child transmission (13%), blood safety (10%) and condom programs (7%). Only 7% of funding was spent on most-at-risk populations and less than 1% on male circumcision. Spending patterns did not consistently reflect current evidence and the HIV specific transmission context of each country. CONCLUSIONS: Despite recognition of its importance, countries are not allocating resources in ways that are likely to achieve the greatest impact on prevention across all epidemic types. Within prevention spending itself, a greater share of resources need to be matched with interventions that approximate the specific needs and drivers of each country's epidemic.

Impact and Cost of the HIV/AIDS National Strategic Plan for Mozambique, 2015-2019--Projections with the Spectrum/Goals Model.

INTRODUCTION: Mozambique continues to face a severe HIV epidemic and high cost for its control, largely born by international donors. We assessed feasible targets, likely impact and costs for the 2015-2019 national strategic HIV/AIDS plan (NSP). METHODS: The HIV epidemic and response was modelled in the Spectrum/Goals/Resource Needs dynamical simulation model, separately for North/Center/South regions, fitted to antenatal clinic surveillance data, household and key risk group surveys, program statistics, and financial records. Intervention targets were defined in collaboration with the National AIDS Council, Ministry of Health, technical partners and implementing NGOs, considering existing commitments. RESULTS: Implementing the NSP to meet existing coverage targets would reduce annual new infections among all ages from 105,000 in 2014 to 78,000 in 2019, and reduce annual HIV/AIDS-related deaths from 80,000 to 56,000. Additional scale-up of prevention interventions targeting high-risk groups, with improved patient retention on ART, could further reduce burden to 65,000 new infections and 51,000 HIV-related deaths in 2019. Program cost would increase from US$ 273 million in 2014, to US$ 433 million in 2019 for 'Current targets', or US$ 495 million in 2019 for 'Accelerated scale-up'. The 'Accelerated scale-up' would lower cost per infection averted, due to an enhanced focus on behavioural prevention for high-risk groups. Cost and mortality impact are driven by ART, which accounts for 53% of resource needs in 2019. Infections averted are driven by scale-up of interventions targeting sex work (North, rising epidemic) and voluntary male circumcision (Center & South, generalized epidemics). CONCLUSION: The NSP could aim to reduce annual new HIV infections and deaths by 2019 by 30% and 40%, respectively, from 2014 levels. Achieving incidence and mortality reductions corresponding to UNAIDS' 'Fast track' targets will require increased ART coverage and additional behavioural prevention targeting key risk groups.

Levels of spending and resource allocation to HIV programs and services in Latin America and the Caribbean.

BACKGROUND: An estimated 1.86 million people are living with HIV in Latin America and the Caribbean (LAC). The region is comprised of mainly middle-income countries with steady economic growth while simultaneously there are enormous social inequalities and several concentrated AIDS epidemics. This paper describes HIV spending patterns in LAC countries including analysis of the levels and patterns of domestic HIV spending from both public and international sources. METHODS AND FINDINGS: We conducted an extensive analysis of the most recently available data from LAC countries using the National AIDS Spending Assessment tool. The LAC countries spent a total of US$ 1.59 billion on HIV programs and services during the latest reported year. Countries providing detailed information on spending showed that high percentages are allocated to treatment and care (75.1%) and prevention (15.0%). Domestic sources accounted for 93.6 percent of overall spending and 79 percent of domestic funds were directed to treatment and care. International funds represented 5.4 percent of total HIV funding in the region, but they supplied the majority of the effort to reach most-at-risk-populations (MARPs). However, prevalence rates among men who have sex with men (MSM) still reached over 25 percent in some countries. CONCLUSIONS: Although countries in the region have increasingly sustained their response from domestic sources, still there are future challenges: 1) The growing number of new HIV infections and more people-living-with-HIV (PLWH) eligible to receive antiretroviral treatment (ART); 2) Increasing ART coverage along with high prices of antiretroviral drugs; and 3) The funding for prevention activities among MARPs rely almost exclusively on external donors. These threats call for strengthened actions by civil society and governments to protect and advance gains against HIV in LAC.

Estimation of Japanese international financial assistance for HIV/AIDS control for 2003-2007: difficulties and limitations of data collection.

The purpose of this paper is to: (1) collect relevant data and estimate Japanese international financial assistance for HIV/AIDS control; (2) discuss the difficulties in collecting relevant data and the limitations of the collected data; and (3) conduct a comparative analysis on the estimated data with OECD and Kaiser Family Foundation aggregate data. The point is that we have comprehensively collected and estimated the data on Japanese international expenditures for HIV/AIDS control while there is no reliable data that is totally managed and published. In addition, we discuss the difficulties and limitations of data collection: unpublished data; insufficient data; inseparable data; problems of exchange rates; gaps between disbursement and commitment; and difference in year period among calendar, fiscal and organization-specific years. Furthermore, we show the risk of underestimating the Japanese international contribution to HIV/AIDS control on the basis of OECD and Kaiser data. In this respect, it is significant to comprehensively collect and estimate the data on Japanese international assistance for HIV/AIDS control. Finally, we derive the implication that it is crucial for a relevant international organization and/or individual countries to comprehensively collect and administer data for international cooperation in the development of health policies for HIV/AIDS.