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

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Article

Reference

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

KELLY, Sherrie L, et al.

Abstract

To move towards ending AIDS by 2030, HIV resources should be allocated cost-effectively.

We used the Optima HIV model to estimate how global HIV resources could be retargeted for greatest epidemiological effect and how many additional new infections could be averted by 2030.

KELLY, Sherrie L, et al. The global Optima HIV allocative efficiency model: targeting resources in efforts to end AIDS. The Lancet HIV, 2018

DOI : 10.1016/S2352-3018(18)30024-9 PMID : 29540265

Available at:

http://archive-ouverte.unige.ch/unige:104587

Disclaimer: layout of this document may differ from the published version.

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Supplementary materials

Figure S1. Optima HIV epidemiological model structure

Abbreviations include: antiretroviral therapy (ART); cluster of differentiation 4 (CD4) cells per µL.

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Table S1. Modelled countries by region. We selected 44 countries for inclusion in the model with prioritization of countries by number of PLHIV and where data to inform the model was available. Regional percent of PLHIV for each country and capture of regional percent of PLHIV is based on UNAIDS estimates.¹⁸ The number of subnational projects included for select countries are shown. Regional abbreviations include: Eastern Europe and Central Asia (EECA), Latin American and the Caribbean (LAC), Middle East and North Africa (MENA), and sub-Saharan Africa (SSA).

Region/country

Regional percent

of PLHIV

Number of subnational

projects Region/country

Regional percent

of PLHIV

Number of subnational

projects Region/country

Regional percent

of PLHIV

Number of subnational projects

SSA Asia-Pacific EECA

South Africa 27.4% India 41.7% Russian Federation 46.0%

Nigeria 13.6% 6 China 13.9% Ukraine 14.3%

Kenya 6.0% Indonesia 13.6% 2 Belarus 2.3%

Mozambique 5.9% 3 Thailand 8.6% Uzbekistan 2.1%

Uganda 5.7% Viet Nam 5.0% Kazakhstan 1.5%

Zimbabwe 5.6% Cambodia 1.5% Moldova 1.2% 2

Tanzania 5.4% Nepal 0.8% Tajikistan 1.1%

Zambia 4.8% Papua New Guinea 0.8% 3 Georgia 0.6%

Malawi 3.8% Regional total 86.0% Kyrgyzstan 0.5%

Ethiopia 2.9% Armenia 0.2%

Cameroon 2.4% LAC Bulgaria 0.1%

Côte d’Ivoire 1.8% Brazil 41.7% F Yugo Rep Macedonia 0.0%

DR Congo 1.5% Mexico 10.0% Regional total 70.1%

Swaziland 0.9% Colombia 7.4%

Togo 0.4% Haiti 6.7% MENA

Senegal 0.2% Argentina 5.5% Iran 31.8%

Peru 3.3% Sudan 24.3%

Regional total 88.2% Regional total 74.7% Regional total 56.1%

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Table S2. Targeted and non-targeted HIV programmes Targeted HIV programmes

Considered in optimum allocation

Non-targeted HIV programmes Not considered in optimum allocation

Abbreviation Name Abbreviation Name

ART Antiretroviral therapy Human resources

PMTCT Prevention of mother-to-child transmission Enabling environment

OST Opiate substitution therapy Management

HIV testing HIV testing among the general population M&E Monitoring and evaluation SBCC Condoms and social behaviour

change communication

Social protection

OVC Programmes for HIV-related orphans and vulnerable children VMMC Voluntary medical male circumcision Other fixed

prevention

Other fixed prevention, including:

FSW Prevention and testing programmes targeted at female sex workers

Blood safety

Other non-disaggregated prevention MSM Prevention and testing programmes targeted

at men who have sex with men

Pre-exposure prophylaxis

Prevention, diagnosis, and treatment of sexual transmitted infections

Other key pop prevention

Other key population prevention, including: Other HIV care

Other HIV care, including:

Risk-reduction programmes for vulnerable and accessible populations, including migrants, prisoners, and nomadic people

ART linkage, adherence, retention, and support Case management

Laboratory and clinical monitoring (including viral load monitoring) and follow-up

Foster homes/shelters for homeless PLHIV

Other HIV costs

Other HIV costs, including:

Programmes targeting military employees Infrastructure PWID Prevention and testing programmes targeted

at people who inject drugs

Other non-specified HIV costs NSP Needle and syringe programmes

Note: pre-exposure prophylaxis (PrEP), cash transfer programs were not included due to lack of costing data to inform the model

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Table S3. HIV resource allocations by region and globally, 2016 to 2030

HIV resource allocations for last reported budget amount and allocation (LR), optimum allocation to minimize new infections by 2030 with international funds maintained, and optimum allocation to minimize new infections by 2030 with international funds redistributed between countries from 2016 to 2030. These are supporting data for figure 2.

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Table S4. Estimates of cumulative new HIV infections and AIDS-related deaths resulting from last reported and optimum HIV resource allocations when international funds are maintained or redistributed between countries, by region and globally, 2016 to 2030

Estimated cumulative number of new HIV infections and AIDS-related deaths by region and globally resulting from last reported budget amount and allocation (Last reported allocation) and optimum allocation to minimize new infections by 2030 (Optimum allocation) with percent of infections averted if resources are optimized (Averted if optimized (%)) for two scenarios: (1) international funds maintained and (2) international funds redistributed between countries from 2016 to 2030.

Cumulative from 2016 to 2030 Scenario 1 Scenario 2

International funds maintained International funds redistributed between countries Region

New HIV infections (million)

AIDS-related deaths (million)

New HIV infections (million)

AIDS-related deaths (million)

Asia-Pacific Last reported allocation 3·5 3·8 3·5 3·8

Optimum allocation 2·5 2·7 2·8 3·4

Averted if optimized (%) 1·1 (30%) 1·1 (29%) 0·78 (22%) 0·35 (9%)

EECA Last reported allocation 3·1 2·0 3·1 2·0

LAC Last reported allocation 1·3 1·0 1·3 1·0

MENA Last reported allocation 0·29 0·17 0·29 0·17

SSA Last reported allocation 19·7 14·2 19·7 14·2

Global Last reported allocation 28·0 21·1 28·0 21·1

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Table S5. Summary of resource allocations at the national and subnational level, 2016–2030 These are supporting data for figure 3.

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Table S6. Global HIV resource allocations and new infections with varying budget levels, 2016–2030

Supporting data for figure (4A) optimum allocation of annual global HIV programme resources to minimize new HIV infections by 2030 with 20% incremental budget increases from 0% to 200% compared with the last reported (LR) allocation with 100% budget and figure (4B) cumulative new HIV infections by population group from 2016 to 2030 at variable budget levels. As we did not consider non-targeted programme spending within the optimum allocation, these programme allocations were excluded here.