Value for Money in Ukraine’s HIV Response : Strategic Investment and Improved Efficiency

World Bank

World Bank, Washington, DC

关键词: HIV;    health financing;    health expenditure;    antiretroviral therapy;   

RP-ID  :  106815

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Ukraine experiences one of the mostsevere HIV epidemics in Europe. An HIV allocative efficiencyanalysis has been carried out, which revealed that there areseveral key opportunities to change the course of Ukraine’sHIV epidemic:Ukraine’s current HIV response already makesstrategic use of available resources (around US$80 millionin 2013) prioritizing Antiretroviral Therapy (ART) andprevention programs for people who inject drugs (PWID), menwho have sex with men (MSM) and female sex workers (FSW).This investment, which successfully stabilized the epidemic– although at a high level – is unlikely to lead to furtherdeclines in new infections and deaths. The number of peopleon ART could be doubled to 130,000 (around 60 percent of allPLHIV) within the stipulated annual budget. At the time ofcompletion of this study (mid 2015), only around 30 percentof Ukraine’s estimated 223,000 PLHIV received treatmentagainst a global target of 81 percent by 2020. There is needto implement efficient and effective ART scale-up, achievethe national target of 118,240 PLHIV on ART by 2018, andplan for further increasing coverage to reach global targets- with a strong focus on HIV diagnosis among keypopulations.Continued funding for prevention programs forkey populations remains critical beyond 2018.There is needfor enhanced integration of HIV services with services forTuberculosis, drug use treatment including OpioidSubstitution Therapy, blood-borne viruses and sexualhealth.Ukraine’s HIV response requires a shared long-termvision on sustainable HIV financing and needs to harness thewider health sector reforms and emerging financing models.This policy brief is a result of a team effort involving theState Institution Ukrainian Center for Socially DangerousDisease Control of the MOH of Ukraine and internationalpartners. The study was part of the regional initiatives onHIV allocative efficiency analysis and funded andtechnically supported by the World Bank and UNAIDS. Wegreatly acknowledge the contributions of all the teammembers, stakeholders and other partners. There are majoropportunities, but also major risks in relation to HIVinvestment decisions in Ukraine in the coming five years.While decreasing funding would lead to a marked increase indeaths, new infections and future health care costs, a smartapproach to increasing HIV investment, could avert aroundhalf of the new infections and deaths up to 2030 compared tobusiness as usual.