Why and how to monitor the cost and evaluate the cost-effectiveness of HIV services in countries

Abstract

The number of people in the world living with HIV is increasing as HIV-related mortality has declined but the annual number of people newly infected with HIV has not. The international response to contain the HIV pandemic, meanwhile, has grown. Since 2006, an international commitment to scale up prevention, treatment, care and support services in middle and lower-income countries by 2010 has been part of the Universal Access programme, which itself plays an important part in achieving the Millennium Development Goals by 2015. Apart from providing technical support, donor countries and agencies have substantially increased their funding to enable countries to scale up HIV services. Many countries have been developing their HIV monitoring and evaluation systems to generate the strategic information required to track their response and ensure the best use of the new funds. Financial information is an important aspect of the strategic information required for scaling up existing services as well as assessing the effect of new ones. It involves two components: tracking the money available and spent on HIV at all levels, through budget tracking, national health accounts and national AIDS spending assessments, and estimating the cost and efficiency of HIV services. The cost of service provision should be monitored over time, whereas evaluations of the cost-effectiveness of services are required periodically; both should be part of any country's HIV monitoring and evaluation system. This paper provides country examples of the complementary relationship between monitoring the cost of HIV services and evaluating their cost-effectiveness. It also summarizes global initiatives that enable countries to develop their own HIV monitoring and evaluation systems and to generate relevant, robust and up-to-date strategic information.

The cost of treatment and care for people living with HIV infection: implications of published studies, 1999–2008

“…As was recently re-iterated [6], financial information is an important part of the strategic information which policymakers and healthcare professionals require to be able to plan, implement and review programs and services.…”

“…However, as countries are scaling up services, it becomes necessary for them to consider more long-term strategic responses in order for them to obtain the necessary strategic information [6]. Financial and economic information should be estimated routinely from health facilities ranging from tertiary hospitals in capitals, regional and district hospitals as well as primary healthcare units [134].…”

“…In order to achieve the most effective and efficient services, policy makers need robust and contemporary information on the cost and cost-effectiveness of HIV services [6]. However, previous reviews have indicated the existence of a dearth of such cost information, particularly in middle-income and low-income countries [7][8][9].…”

A high affinity inhibitor of human CD59 enhances complement-mediated virolysis of HIV-1: Implications for treatment of HIV-1/AIDS

“…HIV-1 infection leading to AIDS is still a major public health challenge (13). Current treatment (highly active antiretroviral therapy [HAART]) can successfully control plasma levels of HIV-1 RNA below the limits of detection, but cannot eliminate infected cells and trace levels of free virions.…”

International and Domestic Funding for HIV Research: How Much and How is It Spent?

“…HIV research is not limited to basic research or discovering new drugs but also includes providing innovative solutions to implementation or operational problems. The strategic information coming out of such operational research enables providers of services to optimize the effectiveness, efficiency, equity and acceptability of HIV services [14].…”