Futures Group International, Washington, DC, USA.
Health Aff (Millwood). 2012 Jul;31(7):1498-507. doi: 10.1377/hlthaff.2012.0227.
Trade-offs may exist between investments to promote health system strengthening, such as investments in facilities and training, and the rapid scale-up of HIV/AIDS services. We analyzed trends in expenditures to support the prevention of mother-to-child transmission of HIV in Kenya under the President's Emergency Plan for AIDS Relief (PEPFAR) from 2005 to 2010. We examined how expenditures changed over time, considering health system strengthening alongside direct treatment of patients. We focused on two organizations carrying out contracts under PEPFAR: the Elizabeth Glaser Pediatric AIDS Foundation and FHI360 (formerly Family Health International), a nonprofit health and development organization. We found that the average unit expenditure, or the spending on goods and services per mother living with HIV who was provided with antiretroviral drugs, declined by 52 percent, from $567 to $271, during this time period. The unit expenditure per mother-to-infant transmission averted declined by 66 percent, from $7,117 to $2,440. Meanwhile, the health system strengthening proportion of unit expenditure increased from 12 percent to 33 percent during the same time period. The analysis suggests that PEPFAR investments in prevention of mother-to-child transmission of HIV in Kenya became more efficient over time, and that there was no strong evidence of a trade-off between scaling up services and investing in health systems.
在促进卫生系统强化的投资（如设施和培训投资）与艾滋病毒/艾滋病服务的快速扩大之间可能存在权衡。我们分析了肯尼亚在总统艾滋病紧急救援计划（PEPFAR）下从 2005 年到 2010 年支持预防母婴传播艾滋病毒的支出趋势。我们考察了在同时考虑卫生系统强化和直接治疗患者的情况下支出如何随时间变化。我们专注于在 PEPFAR 下执行合同的两个组织：伊丽莎白·格拉泽儿童艾滋病基金会和 FHI360（前身为家庭健康国际），这是一个非营利性的健康和发展组织。我们发现，在此期间，每个接受抗逆转录病毒药物治疗的艾滋病毒携带母亲的平均单位支出（即用于商品和服务的支出）从 567 美元下降到 271 美元，下降了 52%。每个避免母婴传播的单位支出下降了 66%，从 7117 美元降至 2440 美元。与此同时，同一时期，单位支出中用于卫生系统强化的比例从 12%增加到 33%。分析表明，随着时间的推移，PEPFAR 在肯尼亚预防母婴传播艾滋病毒方面的投资变得更加高效，并且在扩大服务和投资卫生系统之间没有强有力的证据表明存在权衡。
