Suthar Amitabh B, Nagata Jason M, Nsanzimana Sabin, Bärnighausen Till, Negussie Eyerusalem K, Doherty Meg C
Department of HIV/AIDS, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland.
Department of Pediatrics, Stanford University School of Medicine, Stanford, USA.
BMC Health Serv Res. 2017 Jan 4;17(1):6. doi: 10.1186/s12913-016-1962-9.
Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines.
PubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207.
Four studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported.
Although the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.
尽管国内用于艾滋病防治的资金在增加，但国际上对艾滋病防治的资金投入已趋于平稳。为卫生系统提供激励措施（即基于绩效的融资[PBF]）可能有助于各国利用现有资源取得更多成效。我们系统回顾了基于绩效的融资对艾滋病服务提供的影响，以为世界卫生组织的指南提供参考。
2015年4月，我们在PubMed、世界卫生组织医学索引、会议数据库和临床试验注册库中搜索了随机试验、同期对照研究或时间序列研究。当研究报告了艾滋病患者的服务质量、可及性或成本时，纳入评估基于绩效的融资对艾滋病患者影响的研究。由于数据有限，无法进行荟萃分析。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42015023207。
2009年至2015年发表的四项研究，共纳入173,262人，符合纳入标准。所有研究均来自撒哈拉以南非洲地区。基于绩效的融资并未提高个体检测覆盖率（相对危险度[RR]为1.00，95%置信区间[CI]为0.89至1.13），但提高了配偶检测覆盖率（RR为1.11，95%CI为1.02至1.20），以及孕妇检测覆盖率（RR为1.29，95%CI为1.28至1.30）。基于绩效的融资提高了孕妇（RR为1.55，95%CI为1.50至1.59）、婴儿（RR为1.92，95%CI为1.84至2.01）和成人（RR为1.74，95%CI为1.64至1.85）的抗逆转录病毒药物覆盖率。基于绩效的融资降低了失访率（RR为0.84，95%CI为0.74至0.96）和治疗失败率（比值比为0.55，95%CI为从0.32至0.97）。未报告潜在危害。
尽管有限的数据表明基于绩效的融资对艾滋病服务的可及性和质量有积极影响，但关键的卫生系统和治理知识差距仍然存在。需要更多研究为国家政策制定提供参考。
