Do Less Harm: Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid.
Ann Intern Med
; 167(9): 618-629, 2017 Nov 07.
Article
em En
| MEDLINE
| ID: mdl-28847013
ABSTRACT
BACKGROUND:
Resource-limited nations must consider their response to potential contractions in international support for HIV programs.OBJECTIVE:
To evaluate the clinical, epidemiologic, and budgetary consequences of alternative HIV program scale-back strategies in 2 recipient nations, the Republic of South Africa (RSA) and Côte d'Ivoire (CI).DESIGN:
Model-based comparison between current standard (CD4 count at presentation of 0.260 × 109 cells/L, universal antiretroviral therapy [ART] eligibility, and 5-year retention rate of 84%) and scale-back alternatives, including reduced HIV detection, no ART or delayed initiation (when CD4 count is <0.350 × 109 cells/L), reduced investment in retention, and no viral load monitoring or second-line ART. DATA SOURCES Published RSA- and CI-specific estimates of the HIV care continuum, ART efficacy, and HIV-related costs. TARGET POPULATION HIV-infected persons, including future incident cases. TIME HORIZON 5 and 10 years. PERSPECTIVE Modified societal perspective, excluding time and productivity costs. OUTCOMEMEASURES:
HIV transmissions and deaths, years of life, and budgetary outlays (2015 U.S. dollars). RESULTS OF BASE-CASEANALYSIS:
At 10 years, scale-back strategies increase projected HIV transmissions by 0.5% to 19.4% and deaths by 0.6% to 39.1%. Strategies can produce budgetary savings of up to 30% but no more. Compared with the current standard, nearly every scale-back strategy produces proportionally more HIV deaths (and transmissions, in RSA) than savings. When the least harmful and most efficient alternatives for achieving budget cuts of 10% to 20% are applied, every year of life lost will save roughly $900 in HIV-related outlays in RSA and $600 to $900 in CI. RESULTS OF SENSITIVITYANALYSIS:
Scale-back programs, when combined, may result in clinical and budgetary synergies and offsets.LIMITATION:
The magnitude and details of budget cuts are not yet known, nor is the degree to which other international partners might step in to restore budget shortfalls.CONCLUSION:
Scaling back international aid to HIV programs will have severe adverse clinical consequences; for similar economic savings, certain programmatic scale-back choices result in less harm than others. PRIMARY FUNDING SOURCE National Institutes of Health and Steve and Deborah Gorlin MGH Research Scholars Award.
Texto completo:
1
Temas:
ECOS
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Aspectos_gerais
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Orçamentos
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Infecções por HIV
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Cooperação Internacional
Tipo de estudo:
Health_economic_evaluation
Limite:
Humans
País/Região como assunto:
Africa
Idioma:
En
Revista:
Ann Intern Med
Ano de publicação:
2017
Tipo de documento:
Article