Spending of HIV resources in Asia and Eastern Europe: systematic review reveals the need to shift funding allocations towards priority populations

Abstract

IntroductionIt is increasingly important to prioritize the most cost-effective HIV interventions. We sought to summarize the evidence on which types of interventions provide the best value for money in regions with concentrated HIV epidemics.MethodsWe conducted a systematic review of peer-reviewed and grey literature reporting measurements of cost-effectiveness or cost-benefit for HIV/AIDS interventions in Asia and Eastern Europe. We also collated HIV/AIDS spending assessment data from case-study countries in the region.ResultsWe identified 91 studies for inclusion, 47 of which were from peer-reviewed journals. Generally, in concentrated settings, prevention of mother-to-child transmission programmes and prevention programmes targeting people who inject drugs and sex workers had lower incremental cost-effectiveness ratios than programmes aimed at the general population. The few studies evaluating programmes targeting men who have sex with men indicate moderate cost-effectiveness. Collation of prevention programme spending data from 12 countries in the region (none of which had generalized epidemics) indicated that resources for the general population/non-targeted was greater than 30% for eight countries and greater than 50% for five countries.ConclusionsThere is a misalignment between national spending on HIV/AIDS responses and the most affected populations across the region. In concentrated epidemics, scarce funding should be directed more towards most-at-risk populations. Reaching consensus on general principles of cost-effectiveness of programmes by epidemic settings is difficult due to inconsistent evaluation approaches. Adopting a standard costing, impact evaluation, benefits calculation, analysis and reporting framework would enable cross comparisons and improve HIV resource prioritization and allocation.

Estimating the Cost-Effectiveness of HIV Prevention Programmes in Vietnam, 2006-2010: A Modelling Study

“…A recent study on population-level cost-effectiveness of the large community-based Avahan programme in south India strongly indicated that KAP-focused interventions are highly cost-effective [ 44 ]. Our findings recommend a shift of available resources away from the general populations and towards the KAPs in Vietnam, which is consistent with a recent systematic review of HIV funding landscape in other Asian settings [ 45 ]. NSPs and condom programmes amongst MSM and FSW/clients should be specifically prioritised.…”

Armed Conflict, Substance Use and HIV: A Global Analysis

“…Many HIV epidemics in the last decade are concentrated among MARPs, specifically people who inject drugs, sex workers and men who have sex with men [36-38]. The preponderance of HIV spending in most countries with concentrated epidemics remain targeted to the general population [39], despite evidence of the effectiveness and low cost of prevention and treatment programs targeting MARPs.…”

The funding landscape for HIV in Asia and the Pacific

“…The average fungibility of aid for HIV has not been well established, with various publications reporting conflicting messages [ 13 , 14 ]. Competing domestic budgetary priorities across the health sector and political agendas mean that domestic resources will not automatically replace declining ODA [ 6 , 15 ]. This issue is an open question into which further research would be very welcome.…”

“…Specifically, prevention programmes for people most at risk of acquiring HIV are almost entirely funded from international sources. Domestically funded prevention programmes are all too often non-targeted or targeted at general lower risk populations [ 15 ]. With all of the accumulated knowledge and evidence, and especially considering the future financing landscape, domestically funded HIV programmes need to deliver effective prevention strategies that focus on key populations and are designed to respond to local conditions and epidemiology.…”