CIAO Focus, December 2013: Innovative Interventions in the Global Fight against HIV/AIDS

To achieve an “AIDS-free generation,” each country must “optimize the returns from AIDS investments, particularly by ensuring greater efficiency”. Each country must determine its optimal strategy – the package of interventions, populations targeted, and the delivery or implementation strategy – to control its AIDS epidemic. In recent years, UNAIDS has emphasized the importance of tailoring a mix or package of interventions to a country’s epidemiology through the UNAIDS Investment Framework and other work on “Know Your Epidemic”, “Modes of Transmission”, and ‘most at-risk populations’ (MARPs).

These analyses have shown likely mismatches between aggregate investments in HIV prevention and the modes of disease transmission. For example, men who have sex with men (MSM) in Latin America tend to receive scant resources for HIV prevention, relative to their central role in the region’s epidemic; at one extreme in Costa Rica, MSM received only 1% of the country’s overall expenditure on HIV prevention, despite representing an estimated 60% of all infections. An analogous mismatch was observed in Ghana, where 99.2% of AIDS funding failed to specifically reach high-risk populations, despite evidence that 76% of HIV transmission in Accra were driven by the commercial sex industry.  While these crude comparisons are not conclusive, they are highly likely to represent suboptimal allocations, even as some interventions for prevention are generally cheaper than treatment.

These forms of international guidance have mainly focused on understanding country epidemiologic contexts through enhanced surveillance and measurement, with lesser emphasis on determining the optimal package or mix of interventions given a budget constraint. The optimal strategy requires, at a minimum, information on the current set of interventions used in country, the relative unit costs of those interventions, and the country’s epidemiologic context.

--Center for Global Development

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