The rapid decrease in international funding for HIV/AIDS has been challenging for many nations to effectively mobilize and allocate their limited resources for HIV/AIDS programs. Economic evaluations can help inform decisions and strategic planning. This study aims to examine the trends and patterns in economic evaluation studies in the field of HIV/AIDS and determine their research landscapes. Using the Web of Science databases, we synthesized the number of papers and citations on HIV/AIDS and economic evaluation from 1990 to 2017. Collaborations between authors and countries, networks of keywords and research topics were visualized using frequency of co-occurrence and Jaccards’ similarity index. A Latent Dirichlet Allocation (LDA) analysis to categorize papers into different topics/themes. A total of 372 economic evaluation papers were selected, including 351 cost-effectiveness analyses (CEA), 11 cost-utility analyses (CUA), 12 cost-benefit analyses (CBA). The growth of publications, their citations and usages have increased remarkably over the years. Major research topics in economic evaluation studies consisted of antiretroviral therapy (ART) initiation and treatment; drug use prevention interventions and prevention of mother-to-child transmission interventions. Moreover, lack of contextualized evidence was found in specific settings with high burden HIV epidemics, as well as emerging most-at-risk populations such as trans-genders or migrants. This study highlights the knowledge and geographical discrepancies in HIV/AIDS economic evaluation literature. Future research directions are also informed for advancing economic evaluation in HIV/AIDS research.

/pdf/economic-evaluation-studies-in-the-field-of-hiv-aids-3mmqtdvo4w.pdf

Economic evaluation studies in the field of HIV/AIDS: bibliometric analysis on research development and scopes (GAPRESEARCH).

Background HIV infection has profound clinical and economic costs at the household level. This is particularly important in low-income settings, where access to additional sources of income or loans may be limited. While several microfinance interventions have been proposed, unconditional cash grants, a strategy to allow participants to choose how to use finances that may improve household security and health, has not previously been evaluated. Methods We examined the effect of an unconditional cash transfer to HIV-infected individuals using a 2 × 2 factorial randomized trial in two rural districts in Uganda. Our primary outcomes were changes in CD4 cell count, sexual behaviors, and adherence to ART. Secondary outcomes were changes in household food security and adult mental health. We applied a Bayesian approach for our primary analysis. Results We randomized 2170 patients as participants, with 1081 receiving a cash grant. We found no important intervention effects on CD4 T-cell counts between groups [mean difference 35.48, 95% credible interval (CrI) -59.9 to 1131.6], food security [odds ratio (OR) 1.22, 95% CrI: 0.47 to 3.02], medication adherence (OR 3.15, 95% CrI: 0.58 to 18.15), or sexual behavior (OR 0.45 95% CrI: 0.12 to 1.55), or health expenditure in the previous 3 weeks (mean difference $2.65, 95% CrI: -9.30 to 15.69). In secondary analysis, we detected an effect of mental planning on CD4 cell count change between groups (104.2 cells, 9% CrI: 5.99 to 202.16). We did not have data on viral load outcomes. Conclusion Although all outcomes were associated with favorable point estimates, our trial did not demonstrate important effects of unconditional cash grants on health outcomes of HIV-positive patients receiving treatment.

Unconditional cash transfers for clinical and economic outcomes among HIV-affected Ugandan households.

Perspectives on HIV/AIDS: American-Based Nigerian Women Who Experienced Polygamy in Rural Nigeria by Christianah O. Olorunfemi MA, Southern New Hampshire University, 2008 MBA, University of Ado-Ekiti, 2001 BSc, Chartered Institute of Marketing, 2000 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University July 2015 Abstract Traditionally, in Nigeria women play a subservient role in relation to men. While a man can practice polygamy by marrying many wives, women cannot marry more than one husband at a time. Although researchers have documented the effects of polygamy on the spread of HIV/AIDS, little is known about the experiences of polygamy by Nigerian women who stopped practicing polygamy by immigrating to the United States without their husbands. It is important to know the experiences of these women as they pertain specifically to the spread of HIV/AIDS so as to develop a preventive intervention for HIV/AIDS among Nigerian women in polygamy. The purpose of this phenomenological study was to explore the perspectives on HIV/AIDS held by 10 Nigerian women who practiced polygamy in Nigeria before immigrating to the United States. Recruitment was done through purposive sampling at a faith-based organization. Guided by the health belief model, interview transcripts from the 10 women were analyzed to reveal recurrent themes that expressed the women’s lived experiences in polygamy with their perspectives on HIV/AIDS. Findings revealed that these women had a basic knowledge of the risk of contracting HIV/AIDS by engaging in polygamy but needed to comply with the terms of sexual encounters as dictated by their husbands; therefore, they were at risk for HIV/AIDS. The results of this study can be used to increase awareness among Nigerian women in polygamy and Nigerian health policy makers regarding the transmission of HIV/AIDS and the preventive measures available for HIV/AIDS. Understanding the experiences of women in polygamy may lead to greater understanding of the impact of polygamy on HIV/AIDS and may help to decrease the prevalence of this disease.Traditionally, in Nigeria women play a subservient role in relation to men. While a man can practice polygamy by marrying many wives, women cannot marry more than one husband at a time. Although researchers have documented the effects of polygamy on the spread of HIV/AIDS, little is known about the experiences of polygamy by Nigerian women who stopped practicing polygamy by immigrating to the United States without their husbands. It is important to know the experiences of these women as they pertain specifically to the spread of HIV/AIDS so as to develop a preventive intervention for HIV/AIDS among Nigerian women in polygamy. The purpose of this phenomenological study was to explore the perspectives on HIV/AIDS held by 10 Nigerian women who practiced polygamy in Nigeria before immigrating to the United States. Recruitment was done through purposive sampling at a faith-based organization. Guided by the health belief model, interview transcripts from the 10 women were analyzed to reveal recurrent themes that expressed the women’s lived experiences in polygamy with their perspectives on HIV/AIDS. Findings revealed that these women had a basic knowledge of the risk of contracting HIV/AIDS by engaging in polygamy but needed to comply with the terms of sexual encounters as dictated by their husbands; therefore, they were at risk for HIV/AIDS. The results of this study can be used to increase awareness among Nigerian women in polygamy and Nigerian health policy makers regarding the transmission of HIV/AIDS and the preventive measures available for HIV/AIDS. Understanding the experiences of women in polygamy may lead to greater understanding of the impact of polygamy on HIV/AIDS and may help to decrease the prevalence of this disease. Perspectives on HIV/AIDS: American-Based Nigerian Women Who Experienced Polygamy in Rural Nigeria by Christianah O. Olorunfemi MA, Southern New Hampshire University, 2008 MBA, University of Ado-Ekiti, 2001 BSc, Chartered Institute of Marketing, 2000 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University July 2015

/pdf/perspectives-on-hiv-aids-american-based-nigerian-women-who-vdxyzmnzdf.pdf

Perspectives on HIV/AIDS: American-Based Nigerian Women Who Experienced Polygamy in Rural Nigeria

This chapter focuses on the framing process of global diseases and its impact on the importance given to certain issues in global health arenas and not others. Using the case of Hepatitis B, a disease largely ignored until recently, despite causing one million deaths every year, it explores the (non)construction of global health problems. The invisibility of the disease is linked to the existence of a vaccine and to the routines of health institutions. Then, it emphasizes the links between the framing of an emerging global problem (Viral Hepatitis) and its possible solutions. Both depend on the beliefs and habits of the individuals involved. The attention given to several blind spots in the global response to the problem accentuates some paradoxes of the construction of global health problems.

Hepatitis B, a Global Disease? On Some Paradoxes of the Construction of Global Health Problems

Considerable advances in HIV prevention and treatment have been made in recent years. The scale of ambition is also mounting, with the end of AIDS now being envisioned by some. Yet alongside this optimism, programmers and researchers continue to wrestle with the contextual complexities of adapting and implementing interventions to different settings. An inherent feature of the implementation challenge is a need to shift the AIDS response from an emergency mode to a programmatic and long term response (Smith et al. 2011, Nixon et al. 2012). This paradigmatic shift is not simple and requires a considered engagement with issues related to the development of new interventions, adaptation of existing interventions to new settings, and the challenges inherent in the implementation of interventions at scale. In every setting, interventions (in their different forms) are entangled with local community dynamics and realities. At this local level, structural issues are very palpable, influencing the way in which people respond to different HIV-related initiatives, and how this shapes the outcomes of prevention and treatment efforts. Thus, while Justin Parkhurst (2013) reminds us that the quest to identify and address the structures that affect HIV-transmission has a long pedigree (see for example, Blankenship et al. 2000 and Sumartojo 2000), the concern about how best to do this continues, and if anything, is mounting, in the era of dwindling HIV resources. Context and timing are now more commonly recognized as being important, with an increasing awareness that a particular intervention to address the drivers of HIV infection in one setting may be applied elsewhere but without success, or an initial change may not be sustained. The factors that shape risk behaviour and the environmental factors that mediate the degree to which people can avoid HIV or access treatment vary not only by where they live, but also how old they are and with whom they interact with across their life-course (Parkhurst 2013). In this series of papers, drawn from the 3rd Structural Drivers of HIV Conference, under the theme Contextualising Structural Drivers of HIV and AIDS, the authors demonstrate a purposeful shift from individualistic perspectives to the importance of understanding how broader social, cultural, economic and environmental factors affect HIV transmission, and lives lived with HIV, for children and adults, women and men, in Africa and elsewhere. The first two papers provide a broad perspective on both the trajectory of the epidemic and the present pre-occupation with treatment scale up and the potential use of `treatment as prevention’. Whiteside and Strauss (2014) propose three transition points: economic, epidemiological and programmatic, that can be charted in the evolution of HIV treatment provision over time. Using data from South Africa the authors build on the work of commentators, such as Mead Over (2011), to discuss how, once an economic transition occurs (where the number of newly infected people falls below the number of deaths of people living with HIV), two further transitions are required. The epidemiological, where the treatment programme scale-up is increasing coverage, and reducing treatment needs, and the programmatic, when the number of people newly initiated onto treatment exceeds the number who need it. To illustrate these transition points, the authors discuss successes in the South African national HIV response, and highlight areas that need increased focus and attention. Whiteside and Strauss (2014) suggest that this approach provides a useful way of tracking the HIV response and progress, in addressing the structural drivers of the epidemic. Wilson and colleagues (2014), further take up the theme of treatment, and stress the importance of understanding and considering the economic feasibility of the scale-up of Treatment as Prevention (TasP). They assert that while TasP shows great promise as a cost-effective intervention to reduce new HIV infections and reduce the global burden of HIV-related disease, the implementation of these programmes face many challenges, because of the large numbers of people in need of treatment. They stress that for TaSP to achieve optimal prevention effects, it will be particularly important to consider the precise context of the epidemic during TasP roll-out, focusing on particular key populations, for example, in more concentrated epidemic settings. They note the continued need for investment in operational research to inform more efficient programme management. The next three papers look at the structural factors which shape individual risk behaviour, focusing on constructions of sexuality, intimacy and love, first sex and alcohol use. Stern and colleagues (2014) used sexual history narratives to investigate how the first sexual encounters of South African men and women influenced their subsequent sexual and reproductive health practice. They compare the different experiences of men and women, highlighting not only the risks often posed to young women coerced into sex by older men, but also the peer pressure recalled by men which prompted them to seek their first sexual experiences. For both men and women these encounters were often unprotected. The authors suggest that these narratives contribute to the evidence needed to develop effective interventions for young people at risk of HIV-infection. In the next paper Ruark and colleagues (2014) explored Swazi men and women’s understandings of multiple or concurrent sexual partnerships in a context where there is a high risk of HIV infection. Their findings show that concurrency was

Addressing structural factors in HIV prevention and treatment

The idea that HIV and AIDS gets too much attention and funding emerged in 2008 with a call to end 'AIDS exceptionalism.' This article outlines a short history of AIDS exceptionalism — the idea that HIV and AIDS require a response above and beyond 'normal' health interventions and is privileged in terms of attention and resources when compared with other diseases — and the reasons for the backlash to this idea. We argue that in some settings HIV and AIDS must be treated as exceptional. These are the hyperendemic countries of southern Africa, where HIV epidemics have shown substantial and lasting demographic and social impact, and parts of Eastern Europe where the epidemic is augmenting troubling demographic changes, such as declines in fertility rates and population growth, and impacting society in nuanced ways. Also included are resource-poor settings, mostly in Africa, where the combination of the high number of HIV infections and the cost of treatment have created issues concerning donor dependency and ...

Why HIV/AIDS should be treated as exceptional: arguments from sub-Saharan Africa and Eastern Europe

Purpose of review Economics, and specifically economic evaluations, are increasingly being utilized to provide treatment policy guidance to decision makers. This article reviews work that has contributed to understanding of the relationship. Recent findings There is a paucity of research explicitly investigating the association between economic evaluations and HIV and AIDS treatment policy. Where it does exist, it is weak. Factors contributing to the limited impact include lack of reliable and trusted data; absence of local cost-effectiveness data for different interventions; contradictory results; challenges associated with understanding complex economic/mathematical models; inefficient implementation of HIV and AIDS policies; inability to pursue long-term health planning needs; and political will. Summary Consideration of the ways in which economic evaluations can have greater influence over HIV and AIDS policies is needed. The weak relationship between the two reflects the complicated and multifaceted decision-making process that is often influenced by socioeconomic and political factors. If an economic evaluation is to influence policy, then cognizance of this is important. Extending the economic toolkit to include broader-based models that incorporate political economy variables, but do not compromise on comprehension, validity and robustness, will offer better informed policy recommendations.

Khaled Ahmed

Papers

Why HIV/AIDS should be treated as exceptional: arguments from sub-Saharan Africa and Eastern Europe

The relationship between economic evaluations and HIV and AIDS treatment policies.