Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

McGillen, Jessica B.; Anderson, Sarah-Jane; Dybul, Mark; Hallett, Timothy B.

doi:10.1016/s2352-3018(16)30051-0

Cited by 76 publications

(71 citation statements)

References 23 publications

(27 reference statements)

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“…TB interventions, such as active case finding and mobile testing units, can be resource-intensive and are utilised most effectively when prioritised to high-burden areas [46]. Subnational differences in HIV burden have also been used to develop locally tailored strategies for HIV prevention and elimination [25, 47–49]. However, the benefits of highly geographically resolved disease burden estimation should be weighed against the risk of potentially identifying individuals if analyses of exceptionally rare outcomes are carried out over very small areas.…”

Section: Discussionmentioning

confidence: 99%

“…Outside of Brazil, there are few national-level spatial modelling studies of TB incidence and, to our knowledge, no nationally comprehensive spatial models of TB mortality at fine spatial scale [22–24]. There are broader spatial modelling efforts for HIV, corresponding to the greater availability of spatially resolved data sources for HIV than for TB in high-burden countries [25, 26]. …”

Section: Introductionmentioning

confidence: 99%

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Progress toward eliminating TB and HIV deaths in Brazil, 2001–2015: a spatial assessment

Ross

Henry

Dwyer-Lindgren

et al. 2018

BMC Med

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BackgroundBrazil has high burdens of tuberculosis (TB) and HIV, as previously estimated for the 26 states and the Federal District, as well as high levels of inequality in social and health indicators. We improved the geographic detail of burden estimation by modelling deaths due to TB and HIV and TB case fatality ratios for the more than 5400 municipalities in Brazil.MethodsThis ecological study used vital registration data from the national mortality information system and TB case notifications from the national communicable disease notification system from 2001 to 2015. Mortality due to TB and HIV was modelled separately by cause and sex using a Bayesian spatially explicit mixed effects regression model. TB incidence was modelled using the same approach. Results were calibrated to the Global Burden of Disease Study 2016. Case fatality ratios were calculated for TB.ResultsThere was substantial inequality in TB and HIV mortality rates within the nation and within states. National-level TB mortality in people without HIV infection declined by nearly 50% during 2001 to 2015, but HIV mortality declined by just over 20% for males and 10% for females. TB and HIV mortality rates for municipalities in the 90th percentile nationally were more than three times rates in the 10th percentile, with nearly 70% of the worst-performing municipalities for male TB mortality and more than 75% for female mortality in 2001 also in the worst decile in 2015. The same municipality ranking metric for HIV was observed to be between 55% and 61%. Within states, the TB mortality rate ratios by sex for municipalities in the worst decile versus the best decile varied from 1.4 to 2.9, and HIV varied from 1.4 to 4.2. The World Health Organization target case fatality rate for TB of less than 10% was achieved in 9.6% of municipalities for males versus 38.4% for females in 2001 and improved to 38.4% and 56.6% of municipalities for males versus females, respectively, by 2014.ConclusionsMortality rates in municipalities within the same state exhibited nearly as much relative variation as within the nation as a whole. Monitoring the mortality burden at this level of geographic detail is critical for guiding precision public health responses.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1131-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Progress toward eliminating TB and HIV deaths in Brazil, 2001–2015: a spatial assessment

Ross

Henry

Dwyer-Lindgren

et al. 2018

BMC Med

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“…All confirmatory test results are treated as 100% specific. The cost of laboratory testing is derived from the 2015 South African National Health Laboratory Service tariff, and the total programme cost of ART in sub-Saharan Africa is based on a previous published estimate [14]. Uncertainty intervals were calculated based on the 95% confidence interval (CI) of the FP point estimate.…”

Section: Cost Of Misdiagnosismentioning

confidence: 99%

Misdiagnosed HIV infection in pregnant women initiating universal ART in South Africa

Hsiao

Zerbe

Phillips

et al. 2017

Journal of the International AIDS Society

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Introduction: Rapid diagnostic tests (RDTs) are the primary diagnostic tools for HIV used in resource-constrained settings. Without a proper confirmation algorithm, there is concern that false-positive (FP) RDTs could result in misdiagnosis of HIV infection and inappropriate antiretroviral treatment (ART) initiation, but programmatic data on FP are few. Methods: We examined the accuracy of RDT diagnosis among HIV-infected pregnant women attending public sector antenatal services in Cape Town, South Africa. We describe the proportion of women found to have started on ART erroneously due to FP RDT results based on pre-ART viral load (VL) testing and enzyme-linked immunosorbent assay (ELISA). Results: We analysed 952 consecutively enrolled pregnant women diagnosed as HIV infected based on two RDTs per local guideline and found 4.5% (43/952) of pre-ART VL results to be <50 copies/ml. After excluding 6 women who had detectable virus on subsequent VL measurements, ELISA was performed on the 37 remaining women. Of these, 3/952 (0.3%) HIV RDT diagnoses were found to be FP. We estimate that using ELISA to confirm all positive RDTs would cost $1110 (uncertainty interval $381–$5382) to identify one patient erroneously initiated on ART, while it costs $3912 for a lifetime of antiretrovirals with VL monitoring for one person. Conclusions: Compared to the cost of confirming the RDT-based diagnoses, the cost of HIV misdiagnosis is high. While testing programmes based on RDT should strive for constant quality improvement, where resources permit, laboratory confirmation algorithms can play an important role in strengthening the quality of HIV diagnosis in the era of universal ART.

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“…Whereas new HIV infections among children have declined by 50% since 2010 thanks to the effective prevention of mother‐to‐child transmission, there has been no decline in new infections among adults since 2010, despite increased antiretroviral treatment coverage (UNAIDS, ). On the programmatic side, higher priority is, therefore, needed for biomedical and behavioural approaches to prevention that are known to be effective and targeted at key populations and hot‐spots of HIV transmission (McGillen, Anderson, Dybul, & Hallett, ). On the financing side, research should determine under which conditions financing should be frontloaded—for example, through borrowing or IFFIm‐type arrangements—in order to boost investments in cost‐reducing prevention programmes.…”

Section: Discussionmentioning

confidence: 99%

What goes wrong with the allocation of domestic and international resources for HIV?

Sterck

2017

Health Economics

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This paper examines how domestic and international financing for HIV is, and ought to be, distributed. We build a theoretical framework that decomposes domestic and international financing for HIV into nonlinear functions of national income, HIV prevalence, and government effectiveness. We test this model, paying particular attention to nonlinearities and to problems of bad controls, multicollinearity, and reverse causality. Finally, we use the fitted values of quartile regressions to study how much countries could reasonably pay domestically and how much they should receive from donors. Worryingly, countries with higher financial means receive on average more aid per PLHIV than very poor ones, and countries with higher HIV prevalence receive on average less aid per people living with HIV. The normative analysis concludes that US$3.08 billion of fiscal space could be created in LIC and MIC. We identify the countries that could be allocated more aid.

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Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

Cited by 76 publications

References 23 publications

Progress toward eliminating TB and HIV deaths in Brazil, 2001–2015: a spatial assessment

Progress toward eliminating TB and HIV deaths in Brazil, 2001–2015: a spatial assessment

Misdiagnosed HIV infection in pregnant women initiating universal ART in South Africa

What goes wrong with the allocation of domestic and international resources for HIV?

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