HIV Insight: Impact and Cost of the HIV/AIDS National Strategic Plan for Mozambique, 2015-2019—Projections with the Spectrum/Goals Model

Mozambique continues to face a severe HIV epidemic and high cost for its control, largely born by international donors. We assessed feasible targets, likely impact and costs for the 2015–2019 national strategic HIV/AIDS plan (NSP).

The HIV epidemic and response was modelled in the Spectrum/Goals/Resource Needs dynamical simulation model, separately for North/Center/South regions, fitted to antenatal clinic surveillance data, household and key risk group surveys, program statistics, and financial records. Intervention targets were defined in collaboration with the National AIDS Council, Ministry of Health, technical partners and implementing NGOs, considering existing commitments.

Implementing the NSP to meet existing coverage targets would reduce annual new infections among all ages from 105,000 in 2014 to 78,000 in 2019, and reduce annual HIV/AIDS-related deaths from 80,000 to 56,000. Additional scale-up of prevention interventions targeting high-risk groups, with improved patient retention on ART, could further reduce burden to 65,000 new infections and 51,000 HIV-related deaths in 2019. Program cost would increase from US$ 273 million in 2014, to US$ 433 million in 2019 for ‘Current targets’, or US$ 495 million in 2019 for ‘Accelerated scale-up’. The ‘Accelerated scale-up’ would lower cost per infection averted, due to an enhanced focus on behavioural prevention for high-risk groups. Cost and mortality impact are driven by ART, which accounts for 53% of resource needs in 2019. Infections averted are driven by scale-up of interventions targeting sex work (North, rising epidemic) and voluntary male circumcision (Center & South, generalized epidemics).

The NSP could aim to reduce annual new HIV infections and deaths by 2019 by 30% and 40%, respectively, from 2014 levels. Achieving incidence and mortality reductions corresponding to UNAIDS’ ‘Fast track’ targets will require increased ART coverage and additional behavioural prevention targeting key risk groups.

Below: Goals model fit to historical HIV prevalence trends, 3 regions of Mozambique. Surveillance/AIM represents the statistical estimates of epidemic trends as of 2014 using the Spectrum/AIM version 5.1, beta 34.

Below: (a) New HIV infections among 15–49 years old adults by risk group, scenario and region, compared to 2014 baseline; (b) HIV infections averted thanks to incremental intervention scale-up over 2015–2019, compared to a scenario with coverage constant at 2014 levels, by region in the ‘Accelerated scale-up’ (C) scenario, adults 15-49-years.

Below: Infections averted (among all ages) from coverage scale-up over 2015–2019, relative to resource needs over 2015–2019, by intervention, in the ‘Accelerated scale-up’ scenario. Both costs and infections averted are discounted, at 3% per year. Abbreviations in Fig 5: ART = Antiretroviral therapy; Sex work = behavioural prevention for Female Sex Workers and their clients; HTC = HIV Testing and Counselling; MSM = Men having sex with men; IDU = Intravenous drug users; PMTCT = Prevention of Mother-to-Child Transmission; VMMC = voluntary medical male circumcision; Youth = behavioural prevention for youth in and out of schools.

Below: Costs and cost drivers of the Mozambique NSP 2015–2019: a) Resource needs, by scenario and intervention; b) PLWH on first-line and second-line ART, ‘Accelerated scale-up’ scenario; c) ART cost break-down, ‘Accelerated scale-up’ scenario. In (a), the dashed line represents resources available and committed from within the national government, other Mozambican implementers, the Global Fund, PEPFAR and other donors–as of January 2015.