Siapka Mariana, Remme Michelle, Obure Carol Dayo, Maier Claudia B, Dehne Karl L, Vassall Anna
SaME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, England .
Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland .
Bull World Health Organ. 2014 Jul 1;92(7):499-511AD. doi: 10.2471/BLT.13.127639. Epub 2014 Apr 1.
To synthesize the data available--on costs, efficiency and economies of scale and scope--for the six basic programmes of the UNAIDS Strategic Investment Framework, to inform those planning the scale-up of human immunodeficiency virus (HIV) services in low- and middle-income countries.
The relevant peer-reviewed and "grey" literature from low- and middle-income countries was systematically reviewed. Search and analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Of the 82 empirical costing and efficiency studies identified, nine provided data on economies of scale. Scale explained much of the variation in the costs of several HIV services, particularly those of targeted HIV prevention for key populations and HIV testing and treatment. There is some evidence of economies of scope from integrating HIV counselling and testing services with several other services. Cost efficiency may also be improved by reducing input prices, task shifting and improving client adherence.
HIV programmes need to optimize the scale of service provision to achieve efficiency. Interventions that may enhance the potential for economies of scale include intensifying demand-creation activities, reducing the costs for service users, expanding existing programmes rather than creating new structures, and reducing attrition of existing service users. Models for integrated service delivery--which is, potentially, more efficient than the implementation of stand-alone services--should be investigated further. Further experimental evidence is required to understand how to best achieve efficiency gains in HIV programmes and assess the cost-effectiveness of each service-delivery model.
综合关于联合国艾滋病规划署战略投资框架六个基本项目的成本、效率以及规模经济和范围经济方面的现有数据，为在低收入和中等收入国家规划扩大人类免疫缺陷病毒（HIV）服务的人员提供参考。
系统回顾了来自低收入和中等收入国家的相关同行评审文献及“灰色”文献。检索和分析遵循系统评价与Meta分析的首选报告项目指南。
在确定的82项实证成本核算和效率研究中，有9项提供了规模经济数据。规模在很大程度上解释了几种HIV服务成本的差异，特别是针对重点人群的有针对性的HIV预防以及HIV检测和治疗的成本差异。有一些证据表明，将HIV咨询和检测服务与其他几种服务整合可产生范围经济。降低投入价格、任务转移和提高服务对象依从性也可能提高成本效率。
HIV项目需要优化服务提供规模以实现效率。可能增强规模经济潜力的干预措施包括加强需求创造活动、降低服务使用者成本、扩大现有项目而非建立新结构以及减少现有服务使用者的流失。应进一步研究综合服务提供模式——这种模式可能比单独提供服务更有效率。需要更多实验证据来了解如何在HIV项目中最佳地实现效率提升，并评估每种服务提供模式的成本效益。
