Summary Objectives Paediatric HIV infection is predominantly vertically transmitted and 90% of the global burden is carried by Sub Saharan Africa. Diagnosis of HIV infection is important to ensure access to appropriate healthcare. Prevention of mother to child transmission (PMTCT) programmes in low resource settings fail to identify HIV‐infected children because of high lost to follow‐up rates by 12 months of age when HIV testing is performed. The cost of diagnosing HIV infection earlier in infancy was measured. Methods A prospective, longitudinal, descriptive study was conducted in a PMTCT clinic in Johannesburg, South Africa over an 18‐month period. From a total of 300 HIV exposed infants enrolled in an infant diagnostic study, a convenience sample of 30 was enrolled in a costing sub‐study. Patient and provider costs incurred in establishing the HIV status of an exposed infant were documented to determine the societal and provider cost of performing HIV testing at 6 weeks and 12 months of age. Results The average societal cost of an earlier diagnosis of HIV is R158 less per patient than current practice as determined from 123 (82%) questionnaires. On average, early diagnosis would cost the provider R8 more per patient. PMTCT clinic attendance figures predict that earlier testing would increase the number of infants diagnosed by almost threefold. Conclusions A marginal additional investment by government to access an earlier HIV diagnosis for infants could triple the efficacy of PMTCT programmes in identifying HIV‐infected children for medical management and improved quality and quantity of life. Early diagnosis offers societal benefits that extend beyond economic savings.
Since 2013, the government of Malawi has been pursuing a number of health reforms, which include plans to increase domestic financing for health through "innovative financing." As part of these reforms, Malawi has sought to raise additional tax revenue through existing and new sources with a view to earmarking the revenue generated to the health sector. In this article, a systematic approach to assessing feasibility and quantifying the amount of revenue that could be generated from potential sources is devised and applied. Specifically, the study applies the Delphi forecasting method to generate a qualitative assessment of the potential for raising additional tax revenues from existing and new sources, and the gross domestic product (GDP)-based effective tax rate forecasting method to quantify the amount of tax revenue that would be generated. The results show that an annual average of 0.30 USD, 0.46 USD, and 0.63 USD per capita could be generated from taxes on fuel and motor vehicle insurance over the period 2016/2017-2021/2022 under the low, medium, and high scenarios, respectively. However, the proposed tax reform has not been officially adopted despite wide consultations and generation of empirical evidence on the revenue potential. The study concludes is that revenue generation potential of innovative financing for health mechanisms in Malawi is limited, and calls for efforts to expand fiscal space for health to focus on efficiency-enhancing measures, including strengthening of governance and public financial management.
IntroductionIn 2014, city leaders from around the world endorsed the Paris Declaration on Fast‐Track Cities, pledging to achieve the 2020 and 2030 HIV targets championed by UNAIDS. The City of Johannesburg – one of South Africa's metropolitan municipalities and also a health district – has over 600,000 people living with HIV (PLHIV), more than any other city worldwide. We estimate what it would take in terms of programmatic targets and costs for the City of Johannesburg to meet the Fast‐Track targets, and demonstrate the impact that this would have.MethodsWe applied the Optima HIV epidemic and resource allocation model to demographic, epidemiological and behavioural data on 26 sub‐populations in Johannesburg. We used data on programme costs and coverage to produce baseline projections. We calculated how many people must be diagnosed, put onto treatment and maintained with viral suppression to achieve the 2020 and 2030 targets. We also estimated how treatment needs – and therefore fiscal commitments – could be reduced if the treatment targets are combined with primary HIV prevention interventions (voluntary medical male circumcision (VMMC), an expanded condom programme, and comprehensive packages for female sex workers (FSW) and young females).ResultsIf current programmatic coverage were maintained, Johannesburg could expect 303,000 new infections and 96,000 AIDS‐related deaths between 2017 and 2030 and 769,000 PLHIV by 2030. Achieving the Fast‐Track targets would require an additional 135,000 diagnoses and 232,000 people on treatment by 2020 (an increase in around 80% over 2016 treatment numbers), but would avert 176,000 infections and 56,500 deaths by 2030. Assuming stable ART unit costs, this would require ZAR 29 billion (USD 2.15 billion) in cumulative treatment investments over the 14 years to 2030. Plausible scale‐ups of other proven interventions (VMMC, condom distribution and FSW strategies) could yield additional reductions in new infections (between 4 and 15%), and in overall treatment investment needs. Scaling up VMMC in line with national targets is found to be cost‐effective in the medium term.ConclusionsThe scale‐up in testing and treatment programmes over this decade has been rapid, but these efforts must be doubled to reach 2020 targets. Strategic investments in proven interventions will help Johannesburg achieve the treatment targets and be on track to end AIDS by 2030.
This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.