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Type of submission: Oral
Conference track: Research
Topics: Drug Policy Reform and Advocacy; Funding and Donors for Harm Reduction
Presenting author: David P. Wilson
David P. Wilson, Clemens Benedikt, Andrew Shattock, Sherrie Kelly, Richard Gray, Feng Zhao, Emiko Masaki, Laura Grobicki, Hassan Haghparast-Bidgoli, Jolene Skordis-Worall, Robyn Stuart, Cliff Kerr, Alona Goroshko, Marelize Görgens, David Wilson
Background: Global HIV incidence targets for 2015 were missed and to achieve the global 2020 target of reducing adult HIV infections to below 500,000 (or by 75% compared to 2010) accelerated action in scaling up HIV programs including for people who inject drugs (PWID) live, is required. In a context of diminishing external support to HIV programs in LMICs with HIV epidemics among PWID, it is essential to use resources efficiently.
Methods: Optima, a dynamic, population-based HIV model with an integrated program and economic analysis framework was applied in eight countries in Eastern Europe and Central Asia. Mathematical modelling using a stochastic descent algorithm established optimized allocations of resources. An implementation efficiency analysis focused on examining technical efficiency, unit costs, and heterogeneity of service delivery models and practices.
Results: Expenditure analysis suggests that countries allocated between 4% (Bulgaria) and 40% (Georgia) of total HIV resources to programs focusing on PWID – with a median of 13% for the eight countries. When distributing the same amount of HIV funding optimally, between 9-25% of available HIV resources would be allocated to PWID programs (median of 16%) and, in addition, antiretroviral therapy would be scaled up including for PWID. Allocative efficiency analyses indicated that optimally most countries should be investing more on PWID. As a result of optimized allocations, new HIV infections are projected to decline by 3-28% and AIDS-related deaths by 7-53%. Implementation efficiencies require reductions in procurement costs, while service delivery models, practices and scale of service delivery influence cost and outcome. A high level of implementation efficiency was associated with high volumes of PWID accessing a drug harm reduction facility.
Conclusion: Optimized allocation of resources, improved implementation efficiency and increased investment of non-HIV resources need to be applied in combination to enhance coverage and improve outcomes of programs for PWID.