ID: 988

Type of submission: Oral

Conference track: Research

Topics: Drug Policy Reform and Advocacy; Funding and Donors for Harm Reduction

Presenting author: David P. Wilson

Presenting author biography:

Professor David Wilson leads the Optima Consortium on Decision Sciences. He worked for 10 years at UNSW as Head of the Disease Modelling. David is currently Head of Infectious Disease Modelling at the Burnet Institute and NHMRC Senior Research Fellow.

Can we make HIV programmes for people who inject drugs more efficient? Findings from allocative and implementation efficiency studies

David P. Wilson, Clemens Benedikt, Andrew Shattock, Sherrie Kelly, Richard Gray, Feng Zhao, Emiko Masaki, Laura Grobicki, Hassan Haghparast-Bidgoli, Jolene Skordis-Worall, Robyn Stuart, Cliff Kerr, Alona Goroshko, Marelize Görgens, David Wilson

Background: Global HIV incidence targets for 2015 were missed and to achieve the global 2020 target of reducing adult HIV infections to below 500,000 (or by 75% compared to 2010) accelerated action in scaling up HIV programs including for people who inject drugs (PWID) live, is required. In a context of diminishing external support to HIV programs in LMICs with HIV epidemics among PWID, it is essential to use resources efficiently.

Methods: Optima, a dynamic, population-based HIV model with an integrated program and economic analysis framework was applied in eight countries in Eastern Europe and Central Asia. Mathematical modelling using a stochastic descent algorithm established optimized allocations of resources. An implementation efficiency analysis focused on examining technical efficiency, unit costs, and heterogeneity of service delivery models and practices.

Results: Expenditure analysis suggests that countries allocated between 4% (Bulgaria) and 40% (Georgia) of total HIV resources to programs focusing on PWID – with a median of 13% for the eight countries. When distributing the same amount of HIV funding optimally, between 9-25% of available HIV resources would be allocated to PWID programs (median of 16%) and, in addition, antiretroviral therapy would be scaled up including for PWID. Allocative efficiency analyses indicated that optimally most countries should be investing more on PWID. As a result of optimized allocations, new HIV infections are projected to decline by 3-28% and AIDS-related deaths by 7-53%. Implementation efficiencies require reductions in procurement costs, while service delivery models, practices and scale of service delivery influence cost and outcome. A high level of implementation efficiency was associated with high volumes of PWID accessing a drug harm reduction facility.

Conclusion: Optimized allocation of resources, improved implementation efficiency and increased investment of non-HIV resources need to be applied in combination to enhance coverage and improve outcomes of programs for PWID.