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Decision Making for HIV Prevention and Treatment Scale up

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  • Sabina S. Alistar
  • Margaret L. Brandeau

Abstract

Background . Effectively controlling the HIV epidemic will require efficient use of limited resources. Despite ambitious global goals for HIV prevention and treatment scale up, few comprehensive practical tools exist to inform such decisions. Methods . We briefly summarize modeling approaches for resource allocation for epidemic control, and discuss the practical limitations of these models. We describe typical challenges of HIV resource allocation in practice and some of the tools used by decision makers. We identify the characteristics needed in a model that can effectively support planners in decision making about HIV prevention and treatment scale up. Results . An effective model to support HIV scale-up decisions will be flexible, with capability for parameter customization and incorporation of uncertainty. Such a model needs certain key technical features: it must capture epidemic effects; account for how intervention effectiveness depends on the target population and the level of scale up; capture benefit and cost differentials for packages of interventions versus single interventions, including both treatment and prevention interventions; incorporate key constraints on potential funding allocations; identify optimal or near-optimal solutions; and estimate the impact of HIV interventions on the health care system and the resulting resource needs. Additionally, an effective model needs a user-friendly design and structure, ease of calibration and validation, and accessibility to decision makers in all settings. Conclusions . Resource allocation theory can make a significant contribution to decision making about HIV prevention and treatment scale up. What remains now is to develop models that can bridge the gap between theory and practice.

Suggested Citation

  • Sabina S. Alistar & Margaret L. Brandeau, 2012. "Decision Making for HIV Prevention and Treatment Scale up," Medical Decision Making, , vol. 32(1), pages 105-117, January.
    • Handle: RePEc:sae:medema:v:32:y:2012:i:1:p:105-117
    DOI: 10.1177/0272989X10391808
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    References listed on IDEAS

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    1. Richter, Anke & Hicks, Katherine A. & Earnshaw, Stephanie R. & Honeycutt, Amanda A., 2008. "Allocating HIV prevention resources: A tool for state and local decision making," Health Policy, Elsevier, vol. 87(3), pages 342-349, September.
    2. Broomberg, Jonathan & Soderlund, Neil & Mills, Anne, 1996. "Economic analysis at the global level: a resource requirement model for HIV prevention in developing countries," Health Policy, Elsevier, vol. 38(1), pages 45-65, October.
    3. Stephanie Earnshaw & Katherine Hicks & Anke Richter & Amanda Honeycutt, 2007. "A linear programming model for allocating HIV prevention funds with state agencies: a pilot study," Health Care Management Science, Springer, vol. 10(3), pages 239-252, September.
    4. Margaret Brandeau & Gregory Zaric, 2009. "Optimal investment in HIV prevention programs: more is not always better," Health Care Management Science, Springer, vol. 12(1), pages 27-37, March.
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    Cited by:

    1. Kjell Hausken & Mthuli Ncube, 2020. "Game theoretic analysis of persons, the pharmaceutical industry, and donors in disease contraction and recovery," Palgrave Communications, Palgrave Macmillan, vol. 7(1), pages 1-17, December.
    2. Robyn M Stuart & Cliff C Kerr & Hassan Haghparast-Bidgoli & Janne Estill & Laura Grobicki & Zofia Baranczuk & Lorena Prieto & Vilma Montañez & Iyanoosh Reporter & Richard T Gray & Jolene Skordis-Worra, 2017. "Getting it right when budgets are tight: Using optimal expansion pathways to prioritize responses to concentrated and mixed HIV epidemics," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-13, October.
    3. Sarah Kok & Alexander Rutherford & Reka Gustafson & Rolando Barrios & Julio Montaner & Krisztina Vasarhelyi, 2015. "Optimizing an HIV testing program using a system dynamics model of the continuum of care," Health Care Management Science, Springer, vol. 18(3), pages 334-362, September.
    4. Sabina Alistar & Elisa Long & Margaret Brandeau & Eduard Beck, 2014. "HIV epidemic control—a model for optimal allocation of prevention and treatment resources," Health Care Management Science, Springer, vol. 17(2), pages 162-181, June.
    5. Hausken, Kjell & Ncube, Mthuli, 2015. "Policy-Makers, the International Community and People Living with HIV: The Need for New Commitment Mechanisms," UiS Working Papers in Economics and Finance 2015/6, University of Stavanger.

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