Chang Judy, Hijazi Mai, Baker Susanna, Igboelina Onyeka, Mann Carlyn, Marqusee Hannah, Nguyen Cam Anh, Piña Carolina, Pius Jemeh, Stanley Robert, Zeh Akiy Zacheaus
Office of HIV/AIDS, Global Health Bureau, U.S. Agency for International Development (USAID), Washington DC, USA.
HIV/AIDS and Tuberculosis Office, USAID Nigeria, Abuja, Nigeria.
BMC Health Serv Res. 2025 May 28;24(Suppl 1):1671. doi: 10.1186/s12913-025-12528-9.
Begun in 2014, the Sustainable Financing Initiative (SFI) was dedicated to mobilizing domestic resources for the HIV response. Among its three programmatic pillars was a focus on ensuring financial protection for people living with HIV (PLHIV). SFI's activities were founded on a strong understanding of and alignment with partner government priorities, as well as costing and actuarial analyses, which allowed for the development of context-specific approaches for improving financial protection for PLHIV. SFI implemented financial protection activities in a total of nine countries; the five countries with the most substantial investments are discussed in this paper. In Vietnam, SFI's support helped the country to integrate almost all outpatient HIV treatment facilities into the public health system, attain enrollment of 90% of PLHIV into Social Health Insurance (SHI), and increase domestic funding for HIV through SHI. In Cambodia, SFI supported the development of a guiding framework for integration of HIV/AIDS services into the existing health system; key achievements included a policy change that expanded eligibility for the country's Health Equity Fund, allowing all PLHIV to access free health services. In the Dominican Republic, SFI support led to the inclusion of antiretroviral drugs in the family health insurance benefit package, increased enrollment of PLHIV in health insurance, and expanded care options through non-governmental organizations. In Nigeria, SFI's support helped to enroll more than 600,000 people and empanel 216 health facilities into the Lagos State Health Insurance Scheme. In Cameroon, SFI support helped the government achieve stepwise progress on key building blocks of its planned new universal health coverage system; SFI contributed to the development of a consolidated package of services, standardized care and service protocols, and accreditation criteria. SFI's investments in financial protection demonstrated that with strong political will; long-term engagement with partner governments; and focused technical assistance for advocacy, policy reform, and implementation support, HIV services can be successfully integrated into financial protection systems. Such integration can promote increased, long-term domestic financing for HIV while also protecting PLHIV from financial risk.
可持续融资倡议（SFI）始于2014年，致力于为应对艾滋病毒筹集国内资源。其三大计划支柱之一是专注于确保为艾滋病毒感染者（PLHIV）提供财务保护。SFI的活动基于对伙伴政府优先事项的深入理解和契合，以及成本核算和精算分析，从而能够制定针对具体情况的方法来改善对艾滋病毒感染者的财务保护。SFI在总共九个国家开展了财务保护活动；本文讨论了五个投资最多的国家。在越南，SFI的支持帮助该国将几乎所有门诊艾滋病毒治疗设施纳入公共卫生系统，使90%的艾滋病毒感染者加入社会医疗保险（SHI），并通过SHI增加了国内对艾滋病毒防治的资金投入。在柬埔寨，SFI支持制定了将艾滋病毒/艾滋病服务纳入现有卫生系统的指导框架；主要成果包括一项政策变革，扩大了该国卫生公平基金的资格范围，使所有艾滋病毒感染者都能获得免费医疗服务。在多米尼加共和国，SFI的支持导致家庭健康保险福利套餐中纳入了抗逆转录病毒药物，增加了艾滋病毒感染者的医疗保险参保人数，并通过非政府组织扩大了护理选择。在尼日利亚，SFI的支持帮助超过60万人登记，并使216家卫生设施加入拉各斯州医疗保险计划。在喀麦隆，SFI的支持帮助政府在其计划中的新全民健康覆盖系统的关键组成部分上取得了逐步进展；SFI为制定综合服务套餐、标准化护理和服务协议以及认证标准做出了贡献。SFI在财务保护方面的投资表明，凭借坚定的政治意愿、与伙伴政府的长期合作以及针对宣传、政策改革和实施支持的重点技术援助，艾滋病毒服务能够成功纳入财务保护系统。这种整合可以促进国内对艾滋病毒防治的长期资金增加，同时也保护艾滋病毒感染者免受财务风险。
