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

• DOI: 10.1371/journal.pone.0169530
• Publication Date: 2017-02-16T16:42:54Z
• Authors: Andrew J. Shattock; Clemens Benedikt; Aliya Bokazhanova; Predrag Đurić; Irina Petrenko; Lolita Ganina; Sherrie L. Kelly; Robyn M. Stuart; Cliff C. Kerr; Tatiana Vinichenko; Shufang Zhang; Christoph Hamelmann; Manoela Manova; Emiko Masaki; David P. Wilson; Richard T. Gray
• Keywords: Male; HIV AIDS; Cost-Benefit Analysis; 3207 Medical Microbiology; 32 Biomedical and Clinical Sciences; HIV Infections; BUDGET; HIV EPIDEMIC; 0302 clinical medicine; FISCAL RISK; Child; Q; R; 1. No poverty; 005; 3 Good Health and Well Being; Health Care Costs; Middle Aged; Kazakhstan; 3. Good health; Infectious Diseases; ANTI-RETROVIRAL THERAPY; Anti-Retroviral Agents; Child, Preschool; HIV/AIDS; Medicine; Female; Infection; Research Article; Adult; 330; Adolescent; Science; 613; HIV DIAGNOSIS; Resource Allocation; Young Adult; 03 medical and health sciences; anzsrc-for: 32 Biomedical and Clinical Sciences; Financial Support; Humans; Preschool; anzsrc-for: 3207 Medical Microbiology; Health Services Needs and Demand; Health Plan Implementation; Infant, Newborn; HIV; Infant; Newborn; HIV-1; Sexually Transmitted Infections; FISCAL TRENDS; ALLOCATIVE EFFICIENCY

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.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.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.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.