Long-Term Financing Needs for HIV Control in Sub-Saharan Africa in 2015-2050

OBJECTIVES:

To estimate the present value of current and future funding needed for HIV treatment and prevention in 9 sub-Saharan African (SSA) countries that account for 70% of HIV burden in Africa under different scenarios of intervention scale-up. To analyse the gaps between current expenditures and funding obligation, and discuss the policy implications of future financing needs.

DESIGN:

We used the Goals module from Spectrum, and applied the most up-to-date cost and coverage data to provide a range of estimates for future financing obligations. The four different scale-up scenarios vary by treatment initiation threshold and service coverage level. We compared the model projections to current domestic and international financial sources available in selected SSA countries.

RESULTS:

In the 9 SSA countries, the estimated resources required for HIV prevention and treatment in 2015-2050 range from US$98 billion to maintain current coverage levels for treatment and prevention with eligibility for treatment initiation at CD4 count of <500/mm(3) to US$261 billion if treatment were to be extended to all HIV-positive individuals and prevention scaled up. With the addition of new funding obligations for HIV-which arise implicitly through commitment to achieve higher than current treatment coverage levels-overall financial obligations (sum of debt levels and the present value of the stock of future HIV funding obligations) would rise substantially.

CONCLUSIONS:

Investing upfront in scale-up of HIV services to achieve high coverage levels will reduce HIV incidence, prevention and future treatment expenditures by realising long-term preventive effects of ART to reduce HIV transmission. Future obligations are too substantial for most SSA countries to be met from domestic sources alone. New sources of funding, in addition to domestic sources, include innovative financing. Debt sustainability for sustained HIV response is an urgent imperative for affected countries and donors.

Below:  Annual resources required by nine sub-Saharan countries (US$ billions) from 2015 to 2050 (3% discounting).

Below:  Per capita annual resources required by nine sub-Saharan countries ($US) from 2015 to 2050 (3% discounting).

Below:  Total expenditures on HIV from domestic and international sources combined (current US$) in selected sub-Saharan African countries, compared with estimated resource needs for treatment, prevention and structural interventions in 2015 under different coverage levels and eligibility for treatment. EAE, external AIDS expenditure; GEA, Government Expenditure on AIDS; RNE, resource needs estimate. GEA and EAE estimates are from Resch et al 2015.

Full article at:   http://goo.gl/C2PXSW

By:  Atun R¹, Chang AY¹, Ogbuoji O¹, Silva S¹, Resch S¹, Hontelez J¹, Bärnighausen T¹.

¹Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.

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Dried Blood Spot Test for HIV Exposed Infants and Children and Their Anti-Retro Viral Treatment Status in Selected Hospitals in Ethiopia

BACKGROUND:

Infants and children living with HIV receive antiretroviral treatment often late, are exposed to opportunistic infection and quickly develop AIDS. Few hospitals are providing ART service after Dried Blood Spot (DBS)test.The objective of this study is to assess the status of infants and children linked to ART.

METHODS:

Descriptive cross-sectional study was conducted in hospitals. Data of 138 infants and children exposed to HIV were collected from registration books and data bases from 2009 to 2011. Data were analyzed using SPSS version 16. Chi-squared test and p-value were computed. In-depth interviews were conducted with key informants.

RESULT:

Ninety-eight (71%) infants and children exposed to HIV were diagnosed for HIV infection of which 68(69.4%) initiated ART. Twenty four (35.3%) initiated ART one month after HIV screening results. Thirty-three (50.0%) and 23(35.3%) infants and children dropped from and adhered to ART respectively. Eleven (16.2%) of them who initiated ART died within the study period. HIV infection status (p-value=0.003), dropping from ART (p-value=0.002) and death after ART initiation (p-value=0.010) showed significance with mothers' PMTCT service status.

CONCLUSION:

Seven in ten HIV-exposed infants and children were diagnosed with HIV, and almost all of them initiated ART. The overall turnaround time was 10 days. Based up on mothers' PMTCT service status, there was a significant difference among HIV-exposed infants and children in acquiring HIV infection from mothers during pregnancy (p-value=0.003) and dropping from ART (p-value=0.010). There were challenges in sample collection and transportation. Early HIV screening during pregnancy and PMTCT service should be strengthened.

Treatment and mortality status of HIV diagnosed with infants and children, 2009–2011.

Variable		Number	Percent
Age in months	< 6	72	52.2
	7–12	59	42.8
	13–18	7	5.0
	Total	138	100
Sex	Male	67	48.6
	Female	71	51.4
	Total	138	100
HIV status	HIV+	98	71.0
	HIV−	40	29.0
Was child initiated ART	Yes	68	69.4
	No	30	30.6
	Total	98	100
Was child dropped ART	Yes	34	50.0
	No	34	50.0
	Total	68	100
Mortality status	Yes	11	16.2
	No	23	33.8
	Unknown	34	50.0
	Total	68	100
Was child adhered to ART	Yes	27	79.4
	No	7	20.6
	Total	34	100

Full article at:   http://goo.gl/20yqnC

By:  Wondafrash B1, Hiko D2.

• 1Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
• 2Depatement of Epidemiology, Jimma University, Jimma, Ethiopia. 
• Ethiop J Health Sci. 2016 Jan;26(1):17-24.

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Factors Influencing the Uptake of Voluntary HIV Counseling & Testing in Rural Ethiopia

Background

Voluntary counseling and testing (VCT) has been one of the key policy responses to the HIV/AIDS epidemic in Ethiopia. However, the utilization of VCT has been low in the rural areas of the country. Understanding factors influencing the utilization of VCT provides information for the design of context based appropriate strategies that aim to improve utilization. This study examined the effects of socio-demographic and behavioral factors, and health service characteristics on the uptake of VCT among rural adults in Ethiopian.

Methods/design

This study was designed as a cross sectional study. Data from 11,919 adults (6278 women aged 15–49 years and 5641 men aged 15–59 years) residing in rural areas of Ethiopia who participated in a national health extension program evaluation were used for this study. The participants were selected from ten administrative regions using stratified multi-stage cluster sampling. Multivariate logistic regression analysis was performed accounting for factors associated with the use of VCT service.

Results

Overall, men (28 %) were relatively more likely to get tested for HIV than women (23.7 %) through VCT. Rural men and women who were young and better educated, who perceived having small risk of HIV infection, who had comprehensive knowledge, no stigmatization attitude and discussed about HIV/AIDS with their partner, and model-family were more likely to undergone VCT. Regional state was also strongly associated with VCT utilization in both men and women. Rural women who belonged to households with higher socio-economic status, non-farming occupation, female-headed household and located near health facility, and who visited health extension workers and participated in community conversation were more likely to use VCT. Among men, agrarian lifestyle was associated with VCT use.

Conclusions

Utilization of VCT in the rural communities is low, and socio-economic, behavioral and health service factors influence its utilization. For increasing the utilization of VCT service in rural areas, there is a need to target the less educated, women, poor and farming families with a focus on improving knowledge and reducing HIV/AIDS related stigma. Strategy should include promoting partner and community conversations, accelerating model-family training, and using alternative modes of testing.

Background characteristics of study population by gender, rural Ethiopia, 2010

		Total		Women		Men
Variables		N	%	N	%	N	%
Socio-demographic variables
Overall		11,919		6278	52.7	5641	47.3
Age group, year
	15–19	1342	11.3	770	12.3	572	10.1
	20–24	1785	15.0	1123	17.9	662	11.7
	25–29	2196	18.4	1357	21.6	839	14.9
	30–39	3635	30.5	1921	30.6	1714	30.4
	40+	2961	24.8	1107	17.6	1854	32.9
Marital status
	Married	9400	78.9	4973	79.3	4427	78.5
	Never married	1860	15.6	758	12.1	1102	19.6
	Divorced/Widowed	651	5.5	542	8.6	109	1.9
Educational level
	Never attended/<1 year	6934	58.2	4386	70.9	2548	47.1
	Primary	2835	23.8	1183	19.1	1652	30.5
	Secondary or higher	1832	15.4	619	10.0	1213	22.4
Gender of household head
	Female	1794	15.1	1233	19.7	561	10.0
	Male	10,113	84.8	5041	80.4	5072	90.0
Occupation of household head
	Farmer	10,688	89.7	5599	90.3	5089	91.3
	Gov't employee/merchant	569	4.8	314	5.1	255	4.6
	Other	519	4.4	291	4.7	228	4.1
Religion
	Orthodox	4749	39.8	2493	39.8	2256	40.1
	Islam	4122	34.6	2170	34.6	1952	34.7
	Protestant	2527	21.2	1331	21.3	1196	21.3
	Other	494	4.1	270	4.3	224	4.0
Socio-economic status index
	Low	2084	17.5	1123	17.9	961	17.1
	Low-middle	4192	35.2	2233	35.6	1959	34.8
	Middle	3586	30.1	1863	29.7	1723	30.6
	High-middle	1720	14.4	884	14.1	836	14.8
	High	329	2.8	170	2.7	159	2.8
Settlement pattern
	Pastoral/agro-pastoral	1724	14.5	909	14.5	815	14.5
	Agrarian	10,195	85.5	5369	85.5	4826	85.6
Region
	Tigray	1152	9.7	622	9.9	530	9.4
	Afar	358	3.0	191	3.0	167	3.0
	Amhara	2677	22.5	1409	22.4	1268	22.5
	Oromia	2852	23.9	1461	23.3	1391	24.7
	Benshangul-Gumuz	644	5.4	330	5.3	314	5.6
	SNNP	2063	17.3	1052	16.8	1011	17.9
	Gambela	1128	9.5	649	10.3	479	8.5
	Dire Dawa	137	1.1	83	1.3	54	1.0
	Harari	170	1.4	93	1.5	77	1.4
	Somali	738	6.2	388	6.2	350	6.2
Behavioral variables
Risk partner in past 12 months
	No	11,694	98.1	6177	98.4	5517	97.8
	Yes	225	1.9	101	1.6	124	2.2
Self-perceived risk of HIV
	No risk	7128	59.8	3581	57.0	3547	62.9
	Small risk	1183	9.9	573	9.1	610	10.8
	Moderate/great risk	708	5.9	360	5.7	348	6.2
	Don’t know	2900	24.3	1764	28.1	1136	20.1
Believes HIV/AIDS is fatal
	No	2113	17.7	1336	21.3	777	13.8
	Yes	9806	82.3	4942	78.7	4864	86.2
Believes HIV/AIDS can be cured
	No	10,321	86.6	5458	86.9	4863	86.2
	Yes	1598	13.4	820	13.1	778	13.8
HIV/AIDS knowledge index
	None	4151	34.8	2597	41.4	1554	27.6
	Low	2592	21.7	1328	21.2	1264	22.4
	Moderate	3007	25.2	1455	23.2	1552	27.5
	High	2169	18.2	898	14.3	1271	22.5
HIV/AIDS stigma scale
	No stigma	4222	35.4	1907	30.4	2315	41.0
	Low stigma	2049	17.2	1020	16.3	1029	18.2
	Moderate stigma	3009	25.2	1671	26.6	1338	23.7
	High stigma	2639	22.1	1680	26.8	959	17.0
Talked with partner about HIV
	No	6436	54.0	3668	58.4	2768	49.1
	Yes	5483	46.0	2610	41.6	2873	50.9
Programmatic variables
Walking distance to HF
	<=10 min	9510	79.8	5016	79.9	4494	79.7
	10–30 min	1639	13.8	861	13.7	778	13.8
	30+ minutes	770	6.5	401	6.4	369	6.5
Proactively visited HEW
	No	7242	60.8	3839	62.5	3403	62.2
	Yes	4373	36.7	2304	37.5	2069	37.8
HEW visited home
	No	6511	54.6	3474	57.0	3037	55.9
	Yes	5016	42.1	2624	43.0	2392	44.1
Source of HIV information
	Never exposed	1207	10.1	833	13.3	374	6.6
	Only to mass media	745	6.3	338	5.4	407	7.2
	Community conversations	9967	83.6	5107	81.4	4860	86.2
Model-family
	No	11,221	94.1	5917	95.4	5304	95.1
	Yes	555	4.7	283	4.6	272	4.9
VHPs in village
	No	5594	46.9	2995	47.7	2599	46.1
	Yes	6325	53.1	3283	52.3	3042	53.9

Full article at:   http://goo.gl/mlVHQb

By:  Hailay D. Teklehaimanot, Awash Teklehaimanot, Mekonnen Yohannes, and Dawit Biratu

Center forNational Health Development in Ethiopia, Columbia University, Kebele 06, H No 447, PO Box 664 code 1250, Bole Sub City, Addis Ababa Ethiopia

The EarthInstitute, Columbia University, 475 Riverside Drive, Suite 401, New York, NY 10025 USA

College of Health Sciences, Mekelle University, PO Box 1871, Mekelle, Ethiopia

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