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

Andrew P. Craig, Hla-Hla Thein, Lei Zhang, Richard T. Gray, Klara Henderson, David Wilson, Marelize Gorgens, David P. Wilson

Research output: Contribution to journalReview ArticleResearchpeer-review

8 Citations (Scopus)

Abstract

Introduction: It 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. 

Methods: We 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. 

Results: We 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. 

Conclusions: There 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.

Original languageEnglish
Article number18822
Number of pages13
JournalJournal of the International AIDS Society
Volume17
Issue number1
DOIs
Publication statusPublished - 25 Feb 2014
Externally publishedYes

Keywords

  • Asia
  • Concentrated epidemics
  • Cost-benefit analyses
  • Cost-effectiveness
  • Eastern Europe
  • HIV
  • Programme evaluation
  • Systematic review

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