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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State Variation in HIV/AIDS Health Outcomes: The Effect of Spending on Social Services and Public Health

OBJECTIVE:

Despite considerable advances in the prevention and treatment of HIV/AIDS, the burden of new infections of HIV and AIDS varies substantially across the country. Previous studies have demonstrated associations between increased healthcare spending and better HIV/AIDS outcomes; however, less is known about the association between spending on social services and public health spending and HIV/AIDS outcomes. We sought to examine the association between state-level spending on social services and public health and HIV/AIDS case rates and AIDS deaths across the United States.

DESIGN:

We conducted a retrospective, longitudinal study of the 50 U.S. states over 2000-2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000 people matched with a unique dataset of state-level spending on social services and public health per person in poverty.

METHODS:

We estimated multivariable regression models for each HIV/AIDS outcome as a function of the social service and public health spending 1 and 5 years earlier in the state, adjusted for the log of state GDP per capita, regional and time fixed effects, Medicaid spending as % of GDP, and socio-demographic, economic, and health resource factors.

RESULTS:

States with higher spending on social services and public health per person in poverty had significantly lower HIV and AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure (P ≤ 0.05).

CONCLUSION:

Our findings suggest that spending on social services and public health may provide a leverage point for state policymakers to reduce HIV/AIDS case rates and AIDS deaths in their state.

Purchase full article at:   http://goo.gl/6gYf0q

By:  Talbert-Slagle KM1, Canavan ME, Rogan EM, Curry LA, Bradley EH.

• 1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA. 
• AIDS. 2016 Feb 20;30(4):657-63. doi: 10.1097/QAD.0000000000000978.

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 More about map:  http://goo.gl/Zrvl62

Politics, Police Accountability, and Public Health: Civilian Review in Newark, New Jersey

Police brutality, a longstanding civil rights issue, has returned to the forefront of American public debate. A growing body of public health research shows that excessive use of force by police and racial profiling have adverse effects on health for African Americans and other marginalized groups. Yet, interventions to monitor unlawful policing have been met with fierce opposition at the federal, state, and local levels. 

On April 30, 2015, the mayor of Newark, New Jersey signed an executive order establishing a Civilian Complaint Review Board (CCRB) to monitor the Newark Police Department (NPD). Using a mixed-methods approach, this study examined how advocates and government actors accomplished this recent policy change in the face of police opposition and after a 50-year history of unsuccessful attempts in Newark. 

Drawing on official public documents, news media, and interviews conducted in April and May 2015, I propose that: (1) a Department of Justice investigation of the NPD, (2) the activist background of the Mayor and his relationships with community organizations, and (3) the momentum provided by the national Black Lives Matter movement were pivotal in overcoming political obstacles to reform. Examining the history of CCRB adoption in Newark suggests when and where advocates may intervene to promote policing reforms in other US cities.

Purchase full article at:   http://goo.gl/ZSvJcU

By:   McGregor A1.

• 1Princeton University, Princeton, NJ, USA. aleciam@princeton.edu. 

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Twenty Years & Still Counting: Including Women as Participants & Studying Sex & Gender in Biomedical Research

This paper chronicles attempts in the United States over the past 20 years to fully represent women in clinical trials and ensure the study of sex and gender in biomedical research. We maintain that productive science with the aim of serving the public health requires examining the influence of sex and gender on health outcomes.

This section provides a historical perspective on the changes in recommendations and requirements of both the National Institutes of Health — the world’s largest single funder of biomedical research — and the U.S. Food and Drug Administration — the world’s most influential regulator of drugs and medical devices — for the acceptable conduct of research as it relates to sex and gender. We also cite all reports by the U.S. Institute of Medicine and the U.S. Congress’ General Accountability Office issued from 1990 to the present on the inclusion of sex and gender in research, and selected high-impact published studies that illustrate and document the paucity of, yet the need for, inclusion of females and consideration of sex and gender in research across an array of biomedical disciplines.

The key message of this paper is that it has been 20 years since the first requirements to include women as well as men in clinical trials and analyze results by sex were mandated by a U.S. federal law, yet not nearly enough progress has been made. Recent signs of potential change in both policy and practice of scientific inquiry suggest much more progress may be within reach. However, awaiting a cultural shift to allow the study of sex and gender to be embraced is not seen as an effective strategy for change. Rather, specific instrumental recommendations are offered for how to include the study of sex and gender in research so as to increase our understanding and promotion of health for the benefit of all.

Full article at: http://goo.gl/npfrQY

By: Carolyn M. Mazure^12* and Daniel P. Jones²

¹Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

²Women’s Health Research at Yale, Yale School of Medicine, 135 College Street, Suite 220, New Haven 06510, CT, USA

   

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