The global Optima HIV allocative efficiency model: targeting resources in efforts to end AIDS

Kelly, Sherrie L; Martin-Hughes, Rowan; Stuart, Robyn M.; Yap, Xiao F; Kedziora, David J.; Grantham, Kelsey L.; Hussain, Sheharyar; Reporter, Iyanoosh; Shattock, Andrew J.; Grobicki, Laura; Haghparast‐Bidgoli, Hassan; Skordis‐Worrall, Jolene; Barańczuk, Zofia; Keiser, Olivia; Estill, Janne; Petravic, Janka; Gray, Richard T.; Benedikt, Clemens; Fraser, Nicole; Görgens, Marelize; Wilson, David J.; Kerr, Cliff C.; Wilson, David

doi:10.1016/s2352-3018(18)30024-9

Cited by 51 publications

(60 citation statements)

References 13 publications

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“…Whenever country teams work with the Optima HIV model, our recommendation has been to explicitly model 90-90-90 targets and many countries chose to do so in the original studies using the model. Our research using Optima HIV has also demonstrated that scaling-up treatment is typically of highest priority for most countries [10], and this was also a key result in the studies summarized in this article.While we collectively aspire to full coverage of all services for all people in need, especially including testing and treatment, the unfortunate reality is that complete implementation of 90-90-90/95-95-95 may not be feasible to implement in some contexts. The letter and modelling studies by Granich, Gupta and Williams advocate for testing everyone in high-prevalence settings once or twice a year and providing immediate treatment [2].…”

supporting

confidence: 55%

supporting

confidence: 55%

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Optima attempts to objectively and pragmatically assist countries meet their targets most efficiently and effectively

2018

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confidence: 55%

supporting

confidence: 55%

Optima attempts to objectively and pragmatically assist countries meet their targets most efficiently and effectively

2018

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“…If all this is in place, it means that the condom use will be effective. This study population comprised teenagers, with the majority being between the ages of 15 and 17 years (64.5%, n = 223), mostly in grade 11, and they were deemed high-risk for HIV and AIDS because HIV prevalence is highest amongst this age group (7.2 million people living with HIV) [22]. Furthermore, these learners have been reported to have the highest rate of pregnancies (n = 45 [6.6%]) in the circuit [23].…”

Section: Discussionmentioning

confidence: 99%

Assessment of knowledge about condom use among high school students in selected schools of Limpopo Province, South Africa

Chavalala¹,

Lebese²,

Tshivhase³

2019

HIV & AIDS Review

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Introduction:Condoms safeguard against unplanned pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) among all age groups. The HIV transmission rate increases when condoms are not used properly. The purpose of this study was to determine knowledge of condom use amongst high school students. A cross-sectional study was conducted on high school students to assess their knowledge of condom use. A total of 346 eligible learners from various high schools in Shamavunga circuit of Limpopo were selected from grades 10-12 through systematic random sampling. Material and methods:Grade 12 students were comprised the majority of participants (37.3%, n = 129), followed by grade 11 at 35% and grade 10 at 27.7%. The group included more females than males.Results: A total of 307 (88.7%) students indicated that they had knowledge about the protection that condoms provide against HIV and acquired immunodeficiency syndrome (AIDS), STIs, and pregnancy, whereas 39 (11.3%) students indicated insufficient knowledge. Furthermore, 91.3% of the learners reported that condoms cannot be used repeatedly, and 52% knew that condoms are available at no cost from clinics and hospital. Conclusions:The study found knowledge of condom use among high school students was evident, although some knowledge deficiencies were also noted including unrolling a condom before putting on the penis and using a condom with oil-based lubricant. Therefore, specific educational programmes such as life orientation are recommended to increase knowledge. Furthermore, high school students should be encouraged to make use of condoms to prevent sexually transmitted diseases.

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“…Others have explored whether monotherapy or dual therapy can be used safely to reduce costs [12][13][14][15]. Strategic use of newly available generic antiretroviral (ARV) drugs has now entered the cost discussion in high-income countries, with modelling studies projecting significant savings from any increased use of generic ART [16][17][18][19][20][21]. De-simplifying or switching a single-tablet formulation (STF) to two or more tablets (i.e.…”

Section: Introductionmentioning

confidence: 99%

De‐simplifying single‐tablet antiretroviral treatments: uptake, risks and cost savings

et al. 2019

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Objectives As more HIV‐positive individuals receive antiretroviral therapy (ART), payers are seeking options for covering these increased and sustained drug costs. Strategic use of available generic antiretroviral (ARV) formulations may be feasible. De‐simplifying a single‐tablet co‐formulation (STF) into two or more tablets using both brand and generic drugs has been proposed. We determine if voluntary de‐simplification of one STF could be utilized as a cost‐saving strategy. We report on the challenges, uptake, outcomes and cost savings of this initiative. Methods Patients stable on the most commonly used STF (Triumeq®) were offered the option of remaining on Triumeq® or switching to generic abacavir/lamivudine and Tivicay® between 1 January 2015 and 1 January 2018; those starting ART consisting of abacavir/lamivudine/doulutegravir in the same period were offered the option of starting Triumeq® or generic abacavir/laminvudine and Tivicay®. No incentives were provided. We examined the acceptance/decline rates, patient satisfaction, health care outcomes and annual cost savings. Results Of 626 patients receiving Triumeq®, 321 were approached; 177 (55.1%) agreed to de‐simplify. Of patients initiating ART, 62.7% chose the generic co‐formulation. Patients switching to or starting on the generic co‐formulation were more likely to be male, > 45 years old, Caucasian, men who have sex with men (MSM) and more HIV‐experienced, and to have more comorbidities (all P < 0.05). Preference for STF was cited for declining de‐simplification. No concern about generic ARVs was expressed. The rate of viral load > 500 HIV‐1 RNA copies/mL after baseline was 2.7% in switched patients compared with 7.0% in those declining to switch. No de novo resistance occurred. A saving of Cdn$1 319 686 was achieved in the first year. Conclusions Reliance on altruism, while respecting patient autonomy, achieved de‐simplification in > 50% of patients approached, and generated immediate cost savings with no increased risk of adverse events, viral breakthrough or resistance.

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The global Optima HIV allocative efficiency model: targeting resources in efforts to end AIDS

Abstract: World Bank and Australian NHMRC.

Cited by 51 publications

References 13 publications

Optima attempts to objectively and pragmatically assist countries meet their targets most efficiently and effectively

Optima attempts to objectively and pragmatically assist countries meet their targets most efficiently and effectively

Assessment of knowledge about condom use among high school students in selected schools of Limpopo Province, South Africa

De‐simplifying single‐tablet antiretroviral treatments: uptake, risks and cost savings

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