Do Less Harm

Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid
Séminaire, 14 décembre 2017 12h30-14h30
  • Actualité Sciences PoActualité Sciences Po


L'axe « Discriminations et inégalités sociales » du LIEPP a le plaisir de vous inviter au séminaire-déjeuner :

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

Le jeudi 14 décembre de 12h30 à 14h30

salle de réunion du LIEPP

254 boulevard st-Germain, 75007 Paris

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 David Paltiel 

Professeur de santé publique et de management, Yale School of Public Health

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

Pour le texte de la présentation (en anglais). 
Pour plus d'information, allez sur sa page personnelle.

Discutant: Henri BergeronChargé de recherches CNRS, CSO / LIEPP, Coordinateur scientifique de la Chaire Santé de Sciences Po-FNSP


Abstract of the paper:

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.