Do Less Harm

Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid
Seminar, December 14th 2017 12:30pm - 2:30pm
  • Actualité Sciences PoActualité Sciences Po


LIEPP's Discriminations and Social Inequalities Research Group is glad to invite you to attend the lunch-seminar held on:

"Do Less Harm: Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid"

Thursday December 14th, 12:30 pm - 2:30 pm

 LIEPP's Seminar Room

254 boulevard St-Germain, 75007 Paris

(sandwich lunch will be offered)

Please click the following link to register



 David Paltiel 

Professor of Public Health, Professor of Management, and Professor in the Institution for Social and Policy Studies (Yale School of Public Health)

"Do Less Harm: Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid"

Discution by : Henri Bergeron, CNRS Reseracher, CSO/LIEPP, Scientific coordinator of the Sciences Po-FNSP Health Studies Chair



Objective: To evaluate the clinical, epidemiologic, and budgetary consequences of alternative HIV program scale-back strategies in 2 recipient nations, the Republic of South Africa (RSA) and Côte d'Ivoire (CI).

Design: Model-based comparison between current standard  and scale-back alternatives, including reduced HIV detection, no ART or delayed initiation, reduced investment in retention, and no viral load monitoring or second-line ART.

Data Sources: Published RSA- and CI-specific estimates of the HIV care continuum, ART efficacy, and HIV-related costs.

Target Population: HIV-infected persons, including future incident cases.

Time Horizon: 5 and 10 years.

Perspective: Modified societal perspective, excluding time and productivity costs.

Outcome Measures: HIV transmissions and deaths, years of life, and budgetary outlays (2015 U.S. dollars).

Results of Base-Case Analysis: At 10 years, scale-back strategies increase projected HIV transmissions by 0.5% to 19.4% and deaths by 0.6% to 39.1%. Strategies can produce budgetary savings of up to 30% but no more. Compared with the current standard, nearly every scale-back strategy produces proportionally more HIV deaths (and transmissions, in RSA) than savings. When the least harmful and most efficient alternatives for achieving budget cuts of 10% to 20% are applied, every year of life lost will save roughly $900 in HIV-related outlays in RSA and $600 to $900 in CI.

Results of Sensitivity Analysis: Scale-back programs, when combined, may result in clinical and budgetary synergies and offsets.

Limitation: The magnitude and details of budget cuts are not yet known, nor is the degree to which other international partners might step in to restore budget shortfalls.

Conclusion: Scaling back international aid to HIV programs will have severe adverse clinical consequences; for similar economic savings, certain programmatic scale-back choices result in less harm than others.