Department of Global Health, School of Public Health, Boston University, Boston, MA, USA.
Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2021 Jul;24 Suppl 3(Suppl 3):e25707. doi: 10.1002/jia2.25707.
In recent years, many countries have adopted evidence-based budgeting (EBB) to encourage the best use of limited and decreasing HIV resources. The lack of data and evidence for hard to reach, marginalized and vulnerable populations could cause EBB to further disadvantage those who are already underserved and who carry a disproportionate HIV burden (USDB). We outline the critical data required to use EBB to support USDB people in the context of the generalized epidemics of sub-Saharan Africa (SSA).
To be considered in an EBB cycle, an intervention needs at a minimum to have an estimate of a) the average cost, typically per recipient of the intervention; b) the effectiveness of the intervention and c) the size of the intervention target population. The methods commonly used for general populations are not sufficient for generating valid estimates for USDB populations. USDB populations may require additional resources to learn about, access, and/or successfully participate in an intervention, increasing the cost per recipient. USDB populations may experience different health outcomes and/or other benefits than in general populations, influencing the effectiveness of the interventions. Finally, USDB population size estimation is critical for accurate programming but is difficult to obtain with almost no national estimates for countries in SSA. We explain these limitations and make recommendations for addressing them.
EBB is a strong tool to achieve efficient allocation of resources, but in SSA the evidence necessary for USDB populations may be lacking. Rather than excluding USDB populations from the budgeting process, more should be invested in understanding the needs of these populations.
近年来，许多国家采用循证预算编制（EBB）来鼓励充分利用有限且不断减少的艾滋病毒资源。由于缺乏针对难以接触到的、边缘化和弱势人群的数据和证据，循证预算编制可能会使那些已经服务不足且背负不成比例艾滋病毒负担的人（USDB）进一步处于不利地位。我们概述了在撒哈拉以南非洲（SSA）广泛流行的背景下，使用循证预算编制来支持 USDB 人群所需的关键数据。
要在循证预算编制周期中进行考虑，干预措施至少需要有以下方面的估计值：a）每个干预措施接受者的平均成本，通常为每接收者；b）干预措施的效果；c）干预措施目标人群的规模。一般人群中常用的方法不足以对 USDB 人群生成有效估计值。USDB 人群可能需要额外的资源来了解、获得和/或成功参与干预措施，从而增加每个接受者的成本。USDB 人群的健康结果和/或其他获益可能与一般人群不同，从而影响干预措施的效果。最后，USDB 人群规模的估计对于准确规划至关重要，但在 SSA 国家几乎没有国家估计数。我们解释了这些限制并提出了解决这些问题的建议。
循证预算编制是实现资源有效分配的有力工具，但在 SSA，针对 USDB 人群的必要证据可能缺乏。不应该将 USDB 人群排除在预算编制过程之外，而应该投入更多的资源来了解这些人群的需求。
