Kahn James G, Bollinger Lori A, Stover John, Marseille Elliot
Resources devoted to combating the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) have increased dramatically since 2005 (Dieleman and others 2014). However, the rate of increase has slowed in recent years, even though the commitment required to serve all of those in need and to reverse the epidemic has not been reached (Schwärtlander and others 2011; UNAIDS 2013, 2014; WHO 2013). In addition, new recommendations to start treatment earlier in the disease course mean that more resources will be needed than previously estimated. Many of the countries with the highest prevalence of HIV/AIDS have low incomes and carry a heavy burden of other diseases, and it is particularly important to deploy resources judiciously. Finally, efficiency is an even greater imperative in the current era of transition away from funding dominated by international donor aid toward a funding model in which the national governments in affected countries bear a larger portion of the costs; this is especially so since, by some metrics, national governments are failing to increase their own contributions rapidly enough (Resch, Ryckman, and Hecht 2015). Ensuring that available resources are allocated to the most-cost-effective activities is essential to pursuing the aspirational “Getting to Zero” goals of the Joint United Nations Programme on HIV/AIDS (UNAIDS): zero new infections, zero AIDS-related deaths, and zero discrimination. Similar challenges also face global efforts to control tuberculosis and malaria—resources fall short of ambitious prevention and treatment targets. Various effectiveness, cost-effectiveness, and resource allocation models have been developed to evaluate the costs and outcomes of the choices facing HIV/AIDS policy makers at national and international levels. This chapter presents an overview—including features, uses, and limitations—of the small subset of models that explores the allocation of HIV/AIDS resources across many intervention options and purposes. It does not assess the more numerous models that analyze the cost-effectiveness of one or a few interventions for one purpose. Accordingly, it assesses the set of software tools that portray a wide range of interventions and combinations of interventions in different settings with the goal of providing broad guidance for improved resource allocation.
自2005年以来，用于抗击人类免疫缺陷病毒和获得性免疫缺陷综合征（HIV/艾滋病）的资源大幅增加（迪尔曼等人，2014年）。然而，近年来增长速度有所放缓，尽管尚未达到为所有有需要的人提供服务并扭转疫情所需的投入水平（施瓦尔特兰德等人，2011年；联合国艾滋病规划署，2013年、2014年；世界卫生组织，2013年）。此外，在疾病进程中更早开始治疗的新建议意味着需要比先前估计更多的资源。许多HIV/艾滋病患病率最高的国家收入较低，还承受着其他疾病的沉重负担，因此明智地调配资源尤为重要。最后，在当前从以国际捐助援助为主导的资金模式向受影响国家的本国政府承担更大比例费用的资金模式转变的时代，效率更是当务之急；尤其因为从某些指标来看，本国政府自身贡献的增长速度不够快（雷施、里克曼和赫希特，2015年）。确保将可用资源分配到最具成本效益的活动中，对于实现联合国艾滋病联合规划署（UNAIDS）雄心勃勃的“零新增感染、零艾滋病相关死亡、零歧视”的“零艾滋”目标至关重要。全球防治结核病和疟疾的努力也面临类似挑战——资源无法满足宏伟的预防和治疗目标。已经开发了各种有效性、成本效益和资源分配模型，以评估国家和国际层面HIV/艾滋病政策制定者所面临选择的成本和结果。本章概述了一小部分模型——包括其特点、用途和局限性，这些模型探讨了在众多干预选项和目标之间分配HIV/艾滋病资源的情况。本章不评估那些分析单一目的或少数干预措施成本效益的更多模型。因此，本章评估了一系列软件工具，这些工具描绘了不同环境下广泛的干预措施及干预组合，目的是为改善资源分配提供广泛指导。
