Shattock Andrew J, Benedikt Clemens, Bokazhanova Aliya, Đurić Predrag, Petrenko Irina, Ganina Lolita, Kelly Sherrie L, Stuart Robyn M, Kerr Cliff C, Vinichenko Tatiana, Zhang Shufang, Hamelmann Christoph, Manova Manoela, Masaki Emiko, Wilson David P, Gray Richard T
The Kirby Institute, University of New South Wales, Sydney, Australia.
The World Bank Group, Washington DC, United States of America.
PLoS One. 2017 Feb 16;12(2):e0169530. doi: 10.1371/journal.pone.0169530. eCollection 2017.
Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels.
We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure-two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment.
Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%-39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%-58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%-27%] reduction in management costs, and allocating resources optimally.
With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.
尽管哈萨克斯坦的艾滋病疫情持续蔓延，但预计国际捐助者很快将停止对该国的资金支持。在此，我们分析了在未来预算水平的假设下，资源配置效率、实施效率和技术效率如何能够加强该国的艾滋病应对工作。
我们使用Optima模型预测哈萨克斯坦未来艾滋病疫情的情景，这些情景在未来抗逆转录病毒治疗单位成本和管理支出方面有所不同，这两个领域被确定为具有潜在成本降低空间的领域。我们确定了艾滋病项目的最优资源配置，以实现国家目标或雄心勃勃的目标。对于每种情景，我们考虑了未来艾滋病资金的两种情况：将2014年国家预算维持到未来，以及没有当前国际投资的2014年预算。
哈萨克斯坦可以通过以下方式在当前预算下实现其国家艾滋病目标：（1）在各项目之间优化重新分配资源；（2）将抗逆转录病毒治疗药物成本降低35%[30%-39%]，或将管理成本降低到2014年水平的44%[36%-58%]。或者，抗逆转录病毒治疗和管理成本降低的组合可能就足够了。此外，哈萨克斯坦可以通过将抗逆转录病毒治疗成本降低67%，将管理成本降低19%[14%-27%]，并优化资源分配，实现到2020年将新感染病例和与艾滋病相关的死亡人数与2014年水平相比减半的雄心勃勃目标。
鉴于哈萨克斯坦面临捐助者即将撤离的情况，利用现有资源取得更多艾滋病应对成果非常重要。该分析有助于指导艾滋病应对规划者将可用资金用于实现投资的最大收益。哈萨克斯坦国家代表认为所建议的关键变革是现实可行的。
