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    Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies

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    eResearch%204673.pdf (1.698Mb)
    Date
    2017-02-16
    Author
    Shattock, Andrew J.
    Benedikt, Clemens
    Bokazhanova, Aliya
    Duric, Predrag
    Petrenko, Irina
    Ganina, Lolita
    Kelly, Sherrie L.
    Stuart, Robyn M.
    Kerr, Cliff C.
    Vinichenko, Tatiana
    Zhang, Shufang
    Hamelmann, Christoph
    Manova, Manoela
    Masaki, Emiko
    Wilson, David P.
    Gray, Richard T.
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    Citation
    Shattock, A., Benedikt, C., Bokazhanova, A., Duric, P., Petrenko, I., Ganina, L., Kelly, S., Stuart, R., Kerr, C., Vinichenko, T., Zhang, S., Hamelmann, C., Manova, M., Masaki, E., Wilson, D. & Gray, R. (2017) Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies, PLoS ONE, vol. 12, , pp. e0169530,
    Abstract
    Background Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels. Methodology We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure-two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment. Findings Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%-39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%-58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%-27%] reduction in management costs, and allocating resources optimally. Significance With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.
    Official URL
    http://dx.doi.org/10.1371/journal.pone.0169530
    URI
    https://eresearch.qmu.ac.uk/handle/20.500.12289/4673
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