XVIII International AIDS Conference


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Resource needs of 45 countries in achieving the targets of universal access for prioritized services by 2010

W. Zeng1, D.S. Shepard1, J. Chilingerian2, C. Avila-Figueroa3

1Brandeis University, Schneider Institutes for Health Policy, Waltham, United States, 2Brandeis University, Heller School for Social Policy and Management, Waltham, United States, 3The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland

Background: To manage the HIV/AIDS epidemic, international donors have pledged unprecedented commitments for needed services. UNAIDS has projected that low and middle income countries need $25 billion to meet the 2010 HIV/AIDS goal of universal access to AIDS prevention and care, assuming countries' existing efficiency in delivering HIV/AIDS services remains constant. This study develops an alternative estimate of resource needs and gaps assuming that all study countries maximized efficiency.
Methods: We first used data envelopment analysis (DEA) to estimate the technical efficiency of 61 countries in delivering HIV/AIDS services from 2002 to 2007. We considered national HIV/AIDS spending as the input and volume of voluntary counseling and testing (VCT), prevention of mother to child transmission (PMTCT), and antiretroviral treatment (ART) as the outputs. We then employed a Tobit model to adjust the efficiency of national AIDS programs for key social factors (governance, financing mechanisms, income and AIDS epidemic). Finally, we constructed an input-oriented DEA model to project resource needs in 2010 based on the 45 countries with data in 2006.
Results: The average efficiency in implementing HIV/AIDS programs was moderate (50%), with substantial inter-country variation. Using data from 2006, we found that Chad, China, Cote d'Ivoire, Paraguay, South Africa, and Thailand were on the production frontier (with 100% efficiency). At maximal efficiency, their annual projected resource needs were $6.2 billion, about 46% of their UNAIDS estimate of $13.5 billion. Given study countries' spending of $3.9 billion, improving efficiency could narrow the gap from $9.6 to $2.3 billion.
Conclusions: Models that do not incorporate efficiency may overestimate the resource requirement for HIV/AIDS. Similar output-oriented analyses project substantial increases in coverage from improved efficiency with existing resources. Improvements in social factors and the operation of national health care systems might substantially increase efficiency, thereby reducing the resource needs to address HIV/AIDS and increasing services.

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