investments in hiv and aids are paying off by reducing incidence and mortality

Investments in HIV and AIDS are paying off by reducing incidence

and mortality

Carlos Avila, MD, ScD.Abt Associates, Washington DC

Melbourne 22 July 2014

Abt Associates | pg 2

Haitian patient, before and after receiving free treatment for HIV and TB. Photographs by David Walton, Partners in Health. Kim J & Farmer P. NEJM 2006

March 2003 September 2003

People in the poorest places have access to life-prolonging medicines


• There was a relative reduction of 96% in the number of linked HIV-1 transmissions

• Early antiretroviral therapy reduced sexual transmission and clinical events

• The results indicate both personal and public health benefits

Clinical Trial HPTN 052


Problem Statement The number of new infections and deaths have declined

between 15-30%.

An estimated 14 million people are receiving life-saving anti-retroviral treatment (ART).

The world has experienced a widespread of preventive services.

Millions of orphans in poor countries have been provided with education and health care.

Evidence of the impact of HIV investments on health outcomes, based on empirical analysis, is almost non-existent


HIV investments are increasing while new HIV infections have fallen globally

Annual HIV and AIDS investments New HIV infections Global, 2001-2012


Objective and Methods

Objectives: to examine the relationship between investments and HIV incidence as well as AIDS mortality.

Design: Panel data analysis including 63 low- and middle-income countries or 230 country-years data points from 2005 to 2012.

Data Sources: we used publicly available data including: HIV incidence, mortality, HDI, GDP and governance indicators from the World Bank.


Methods – II - Analysis

The common problems typical for panel data such as autocorrelation, stationary of time series and heteroscedasticity were examined carefully.

Fixed and Random Effect models were fitted to analyze association between HIV investments on incidence and mortality.

Dynamic panel specifications were explored and estimated by instrumental variables methods


Findings from panel data analysis

Estimated effect of investments on AIDS-deaths

Dependent Variable Log AIDS mortality per 1000

Fixed Effects Random Effects

Lagged log AIDS expenditures per capita: β (se)

-0.059 (.024) -0.055 (.019)

ρ - value 0.017 0.004 Number observations 264 264Number of countries 63 63

Hausman test suggest that FE model is more appropriate.


Estimated effect of investments on HIV-incidence

Dependent Variable Log HIV-Incidence rateper 1000

Fixed Effects Random Effects

GMM*

Lagged log HIV expenditures β (se)

-0.063 (.029)

0.004 (.031)

-0.015 (.005)

ρ – value 0.032 0.889 <0.05

Number country/years 201 201 63

*Using GNI as Instrumental Variable


Summary

International and domestic investments have a beneficial and statistically significant effect on AIDS mortality

Doubling per capita HIV/AIDS expenditures is associated with a 6% reduction in the AIDS mortality rate.

A 10% increase in HIV spending in the previous year is associated with reduction of 0.15% HIV incidence in the current year.

For the average country in Sub-Saharan Africa, increasing per capita HIV and AIDS investments by US$12 per year is associated with 250,000 fewer AIDS-related deaths or a 20% reduction.


Conclusions

Investments in HIV and AIDS are paying off by reducing new infections and mortality

The estimated effect is small, reflect past resource use and allocation and it is only marginal to other non- measured benefits

Looking forward, the resources needed should be lower, if future efficiencies and targeted responses replace wide investments made during the emergency phase of the global response

Thank you!

Dejan Loncar M.Sc. MBA.The Global Fund, Geneva.Jaya Krishnakumar,PhD.

Department of Economics, University of Geneva.Jose Antonio Izazola MD, ScD.

UNAIDS, Geneva.

investments in hiv and aids are paying off by reducing incidence and mortality

Documents