The 'end of AIDS' project: Mobilising evidence, bureaucracy, and big data for a final biomedical triumph over AIDS.

Efforts are currently underway by major orchestrators and funders of the global AIDS response to realise the vision of achieving an end to AIDS by 2030. Unlike previous efforts to provide policy guidance or to encourage 'best practice' approaches for combatting AIDS, the end of AIDS project involves the promotion of a clear set of targets, tools, and interventions for a final biomedical solution to the epidemic. In this paper, we examine the bureaucratic procedures of one major AIDS funder that helped to foster a common vision and mission amongst a global AIDS community with widely divergent views on how best to address the epidemic. We focus on the methods, movements, and materials that are central to the project of ending AIDS, including those related to biomedical forms of evidence and big data science. We argue that these approaches have limitations and social scientists need to pay close attention to the end of AIDS project, particularly in contexts where clinical interventions might transform clinical outcomes, but where the social, economic, and cultural determinants of HIV and AIDS remain largely intact and increasingly obscured.

A political economy analysis of human resources for health (HRH) in Africa.

BACKGROUND: Despite a global recognition from all stakeholders of the gravity and urgency of health worker shortage in Africa, little progress has been achieved to improve health worker coverage in many of the African human resources for health (HRH) crisis countries. The problem consists in how policy is made, how leaders are accountable, how the World Health Organization (WHO) and foreign donors encourage (or distort) health policy, and how development objectives are prioritized in these countries. METHODS: This paper uses political economy analysis, which stems from a recognition that the solution to the shortage of health workers across Africa involves more than a technical response. A number of institutional arrangements dampen investments in HRH, including a mismatch between officials' tenure in office and program results, the vertical nature of health programming, the modalities of Overseas Development Assistance (ODA) in health, the structures of the global health community, and the weak capacity in HRH units within Ministries of Health. A major change in policymaking would only occur with a disruption to the political or institutional order. RESULTS/CONCLUSIONS: The case study of Ethiopia, who has increased its health workforce dramatically over the last 20 years, disrupted previous institutional arrangements through the power of ideas-HRH as a key intermediate development objective. The framing of HRH created the rationale for the political commitment to HRH investment. Ethiopia demonstrates that political will coupled with strong state capacity and adequate resource mobilization can overcome the institutional hurdles above. Donors will follow the lead of a country with long-term political commitment to HRH, as they did in Ethiopia.

The promise and limitations of cash transfer programs for HIV prevention.

As the search for more effective HIV prevention strategies continues, increased attention is being paid to the potential role of cash transfers in prevention programming in sub-Saharan Africa. To date, studies testing the impact of both conditional and unconditional cash transfers on HIV-related behaviours and outcomes in sub-Saharan Africa have been relatively small-scale and their potential feasibility, costs and benefits at scale, among other things, remain largely unexplored. This article examines elements of a successful cash transfer program from Latin America and discusses challenges inherent in scaling-up such programs. The authors attempt a cost simulation of a cash transfer program for HIV prevention in South Africa comparing its cost and relative effectiveness--in number of HIV infections averted--against other prevention interventions. If a cash transfer program were to be taken to scale, the intervention would not have a substantial effect on decreasing the force of the epidemic in middle- and low-income countries. The integration of cash transfer programs into other sectors and linking them to a broader objective such as girls' educational attainment may be one way of addressing doubts raised by the authors regarding their value for HIV prevention.

The promise andl imitations of cash transfer programs for HIV prevention

As the search for more effective HIV prevention strategies continues; increased attention is being paid to the potential role of cash transfers in prevention programming in sub-Saharan Africa. To date; studies testing the impact of both conditional and unconditional cash transfers on HIV-related behaviours and outcomes in sub-Saharan Africa have been relatively small-scale and their potential feasibility; costs and benefits at scale; among other things; remain largely unexplored. This article examines elements of a successful cash transfer program from Latin America and discusses challenges inherent in scaling-up such programs. The authors attempt a cost simulation of a cash transfer program for HIV prevention in South Africa comparing its cost and relative effectiveness - in number of HIV infections averted - against other prevention interventions. If a cash transfer program were to be taken to scale; the intervention would not have a substantial effect on decreasing the force of the epidemic in middle- and low-income countries. The integration of cash transfer programs into other sectors and linking them to a broader objective such as girls' educational attainment may be one way of addressing doubts raised by the authors regarding their value for HIV prevention

Costing adult male circumcision in high HIV prevalence, low circumcision rate countries.

The dramatic evidence that male circumcision has a substantial effect in preventing HIV infection might be the most important medical finding in the course of the AIDS epidemic since the introduction of highly active antiretroviral therapy (HAART). The transition from clinical trails to implementation of a general adult male circumcision (AMC) program is beginning, and this paper uses an AMC cost model (in Microsoft Excel) to estimate the cost of a rapid scale-up of an AMC program in Mozambique, a country with a generalized epidemic and low rate of male circumcision. There are three major findings: (1) Even the most modest of AMC programs would place great stress on human resources, and task-shifting might lead to more accidents or adverse events that would increase the cost per AMC. (2) The fiscal burden of AMC is surprisingly low, but a rapid scale-up of AMC poses additional fiscal stress for Mozambique's already under-funded public health system. (3) AMC as an HIV prevention tool is very robust in terms of its cost-effectiveness in Mozambique, even at a high AMC accident or complication rate. Any AMC roll-out in Mozambique would face severe constraints in the health system (namely human resources) that would likely limit the scale of an AMC program and perhaps its effectiveness against its generalized epidemic.