Approaches to improving the efficiency of HIV programme investments

Shahid, Minahil; Bharali, Ipchita; Hecht, Robert; Yamey, Gavin

doi:10.1136/bmjgh-2022-010127

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…For instance—stating that success will require cabotegravir to be offered at an affordable price is all the more concerning when injectable PrEP's threshold for cost‐effectiveness in South Africa is <$100 per person‐year [ 61 , 62 ]. Moreover, due to COVID‐19 and ongoing global economic instability, some policymakers and other stakeholders call for strategies to improve efficiencies in HIV investments [ 63 ]. Understanding the current oral PrEP and LAP rollout, full and incremental costs can inform programme efficiencies and financing innovations.…”

Section: Discussionmentioning

confidence: 99%

Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

Castor,

Heck,

Quigee

et al. 2023

J Int AIDS Soc.

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Introduction Several low‐ and middle‐income countries (LMICs) are preparing to introduce long‐acting pre‐exposure prophylaxis (LAP). Amid multiple pre‐exposure prophylaxis (PrEP) options and constrained funding, decision‐makers could benefit from systematic implementation planning and aligned costs. We reviewed national costed implementation plans (CIPs) to describe relevant implementation inputs and activities (domains) for informing the costed rollout of LAP. We assessed how primary costing evidence aligned with those domains. Methods We conducted a rapid review of CIPs for oral PrEP and family planning (FP) to develop a consensus of implementation domains, and a scoping review across nine electronic databases for publications on PrEP costing in LMICs between January 2010 and June 2022. We extracted cost data and assessed alignment with the implementation domains and the Global Health Costing Consortium principles. Results We identified 15 implementation domains from four national PrEP plans and FP‐CIP template; only six were in all sources. We included 66 full‐text manuscripts, 10 reported LAP, 13 (20%) were primary cost studies‐representing seven countries, and none of the 13 included LAP. The 13 primary cost studies included PrEP commodities (n = 12), human resources (n = 11), indirect costs (n = 11), other commodities (n = 10), demand creation (n = 9) and counselling (n = 9). Few studies costed integration into non‐HIV services (n = 5), above site costs (n = 3), supply chains and logistics (n = 3) or policy and planning (n = 2), and none included the costs of target setting, health information system adaptations or implementation research. Cost units and outcomes were variable (e.g. average per person‐year). Discussion LAP planning will require updating HIV prevention policies, technical assistance for logistical and clinical support, expanding beyond HIV platforms, setting PrEP achievement targets overall and disaggregated by method, extensive supply chain and logistics planning and support, as well as updating health information systems to monitor multiple PrEP methods with different visit schedules. The 15 implementation domains were variable in reviewed studies. PrEP primary cost and budget data are necessary for new product introduction and should match implementation plans with financing. Conclusions As PrEP services expand to include LAP, decision‐makers need a framework, tools and a process to support countries in planning the systematic rollout and costing for LAP.

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Section: Discussionmentioning

confidence: 99%

Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

Castor,

Heck,

Quigee

et al. 2023

J Int AIDS Soc.

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“…Lowering the unit costs of HIV commodities and human resources might result in budgetary savings that could be reinvested in the HIV response. 58 Therefore, planners and decision-makers must prioritize allocative efficiency in HIV care and treatment in future resource allocation decisions.…”

Section: Discussionmentioning

confidence: 99%

Stakeholders’ Perspectives on the Financial Sustainability of the HIV Response in Nigeria: A Qualitative Study

Ogbuabor

Olwande

Semini

et al. 2023

Glob Health Sci Pract

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The financial sustainability of the HIV response in Nigeria faces a variety of challenges, including heavy reliance on donor funding that is declining, a low level of domestic funding, and a low level of private-sector financing.n In an effort to improve financing sustainability, integrating HIV testing and treatment services into social health insurance schemes has been slow due to concerns over the high cost of antiretroviral drugs. n Purchasing of HIV treatment and prevention commodities has been inefficient because of the lack of an integrated procurement and supply chain management process.n Despite the high costs associated with providing HIV treatment in hospitals, decentralizing treatment to primary health care centers and shifting tasks to less specialized staff has been slow.

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From Clinical to Non-clinical Outcomes in the Treatment of HIV: An Economic and Organizational Impact Assessment

Lucrezia,

Barbara,

Giuliano

et al. 2024

PharmacoEconomics Open

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Approaches to improving the efficiency of HIV programme investments

Cited by 3 publications

References 45 publications

Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

Stakeholders’ Perspectives on the Financial Sustainability of the HIV Response in Nigeria: A Qualitative Study

From Clinical to Non-clinical Outcomes in the Treatment of HIV: An Economic and Organizational Impact Assessment

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