Optimizing the Allocation of Resources among HIV Prevention Interventions in Honduras

Beeharry, Girindre ; Schwab, Nicole ; Akhavan, Dariush ; Herná ; ndez, Rosalinda ; Paredes, Carla

World Bank, Washington, DC

关键词: DISEASE PREVENTION & CONTROL;    DISEASE TRANSMISSION;    EPIDEMIC DISEASES;    AIDS INFECTIONS;    AIDS INTERVENTIONS;   

RP-ID  :  28860

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

This paper presents a model thatpolicymakers can use to determine the resource allocationthat will prevent the maximum number of new HIV infectionsat any given budget level. The optimal allocation exercisewas conducted in Honduras, where the epidemic is stillconcentrated in high-risk groups but has begun spreadinginto the general population. Most transmissions occurthrough heterosexual sex, followed by sex between men, andmother-to-child transmission. Adult prevalence is estimatedat 1.4 percent. The optimization exercise involves severalsteps:(a) choosing population subgroups targeted forintervention; (b) estimating the proportion of each subgroupthat can be reached; (c) estimating the total number of newinfections expected in each subpopulation; (d) defining theset of HIV prevention interventions to be considered; (e)estimating the unit cost of each intervention; and (f)estimating the expected effectiveness of each intervention.Most of the data required to run the model has to beguesstimated or derived from the literature. To address thischallenge, a group of some forty local and internationalexperts in HIV/AIDS met in Tegucigalpa in May 2002 andarrived at the consensus estimates used in this exercise.They based their estimates on data submitted by two localepidemiologists who had conducted an extensive literaturesearch prior to the workshop. The results from thiscollective exercise show that for limited HIV preventionbudgets (below $500,000), condom social marketing and condomdistribution prevent the maximum number of HIV infections.If the HIV prevention budget is between $750,000 and $2.5million, then Information Education and Communication (IEC)targeted at high risk groups, HIV counseling and access torapid testing, and an information, education andcommunications strategy (IEC) for the Garifunas should alsobe part of the country's prevention strategy. Theexercise shows that some prevention interventions areunattractive even when the HIV prevention budget increasesto $10 million..