The potential to expand antiretroviral therapy by improving health facility efficiency: evidence from Kenya, Uganda, and Zambia
Laura Di Giorgio,Mark Moses,Nancy Fullman,Alexandra Wollum,Ruben Conner,Jane Achan,Tom Achoki,Kelsey Bannon,Roy Burstein,Emily Dansereau,Brendan DeCenso,Kristen Delwiche,Herbert C. Duber,Emmanuela Gakidou,Anne Gasasira,Annie Haakenstad,Michael Hanlon,Gloria Ikilezi,Gloria Ikilezi,Caroline Kisia,Aubrey J. Levine,Mashekwa Maboshe,Felix Masiye,Felix Masiye,Samuel H. Masters,Chrispin Mphuka,Pamela Njuguna,Thomas A. Odeny,Emelda A. Okiro,D. Allen Roberts,Christopher J L Murray,Abraham D. Flaxman +31 more
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In this article, the authors quantified facility-level technical efficiency across countries, assessed potential determinants of efficiency, and predicted the potential for additional ART expansion, and estimated how many additional ART visits could be accommodated if facilities with low efficiency thresholds reached those levels of efficiency.Abstract:
Since 2000, international funding for HIV has supported scaling up antiretroviral therapy (ART) in sub-Saharan Africa. However, such funding has stagnated for years, threatening the sustainability and reach of ART programs amid efforts to achieve universal treatment. Improving health system efficiencies, particularly at the facility level, is an increasingly critical avenue for extending limited resources for ART; nevertheless, the potential impact of increased facility efficiency on ART capacity remains largely unknown. Through the present study, we sought to quantify facility-level technical efficiency across countries, assess potential determinants of efficiency, and predict the potential for additional ART expansion. Using nationally-representative facility datasets from Kenya, Uganda and Zambia, and measures adjusting for structural quality, we estimated facility-level technical efficiency using an ensemble approach that combined restricted versions of Data Envelopment Analysis and Stochastic Distance Function. We then conducted a series of bivariate and multivariate regression analyses to evaluate possible determinants of higher or lower technical efficiency. Finally, we predicted the potential for ART expansion across efficiency improvement scenarios, estimating how many additional ART visits could be accommodated if facilities with low efficiency thresholds reached those levels of efficiency. In each country, national averages of efficiency fell below 50 % and facility-level efficiency markedly varied. Among facilities providing ART, average efficiency scores spanned from 50 % (95 % uncertainty interval (UI), 48–62 %) in Uganda to 59 % (95 % UI, 53–67 %) in Zambia. Of the facility determinants analyzed, few were consistently associated with higher or lower technical efficiency scores, suggesting that other factors may be more strongly related to facility-level efficiency. Based on observed facility resources and an efficiency improvement scenario where all facilities providing ART reached 80 % efficiency, we predicted a 33 % potential increase in ART visits in Kenya, 62 % in Uganda, and 33 % in Zambia. Given observed resources in facilities offering ART, we estimated that 459,000 new ART patients could be seen if facilities in these countries reached 80 % efficiency, equating to a 40 % increase in new patients. Health facilities in Kenya, Uganda, and Zambia could notably expand ART services if the efficiency with which they operate increased. Improving how facility resources are used, and not simply increasing their quantity, has the potential to substantially elevate the impact of global health investments and reduce treatment gaps for people living with HIV.read more
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Journal ArticleDOI
Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015
Joseph L Dieleman,Annie Haakenstad,Angela E Micah,Mark Moses,Cristiana Abbafati,Pawan Acharya,Tara Ballav Adhikari,Arsène Kouablan Adou,Aliasghar Ahmad Kiadaliri,Khurshid Alam,Reza Alizadeh-Navaei,Ala'a Alkerwi,Walid Ammar,Carl Abelardo T. Antonio,Olatunde Aremu,Solomon Weldegebreal Asgedom,Tesfay Mehari Atey,Leticia Avila-Burgos,Ashish Awasthi,Rakesh Ayer,Hamid Badali,Maciej Banach,Amrit Banstola,Aleksandra Barac,Abate Bekele Belachew,Charles Birungi,Nicola Luigi Bragazzi,Nicholas J K Breitborde,Lucero Cahuana-Hurtado,Josip Car,Ferrán Catalá-López,Abigail Chapin,Lalit Dandona,Rakhi Dandona,Ahmad Daryani,Samath D Dharmaratne,Manisha Dubey,Dumessa Edessa,Erika Eldrenkamp,Babak Eshrati,André Faro,Andrea B. Feigl,Ama Pokuaa Fenny,Florian Fischer,Nataliya Foigt,Kyle J Foreman,Nancy Fullman,Mamata Ghimire,Srinivas Goli,Alemayehu Hailu,Samer Hamidi,Hilda L Harb,Simon I. Hay,Delia Hendrie,Gloria Ikilezi,Mehdi Javanbakht,Denny John,Jost B. Jonas,Alexander S Kaldjian,Amir Kasaeian,Jennifer Kates,Ibrahim A Khalil,Young-Ho Khang,Jagdish Khubchandani,Yun Jin Kim,Jonas Minet Kinge,Soewarta Kosen,Kristopher J Krohn,G Anil Kumar,Hilton Lam,Stefan Listl,Hassan Magdy Abd El Razek,Mohammed Magdy Abd El Razek,Azeem Majeed,Reza Malekzadeh,Deborah Carvalho Malta,George A. Mensah,Atte Meretoja,Ted R. Miller,Erkin M. Mirrakhimov,Fitsum Weldegebreal Mlashu,Ebrahim Mohammed,Shafiu Mohammed,Mohsen Naghavi,Vinay Nangia,Frida Namnyak Ngalesoni,Cuong Tat Nguyen,Trang Huyen Nguyen,Yirga Niriayo,Mehdi Noroozi,Mayowa O. Owolabi,David M. Pereira,Mostafa Qorbani,Anwar Rafay,Alireza Rafiei,Vafa Rahimi-Movaghar,Rajesh Kumar Rai,Usha Ram,Chhabi Lal Ranabhat,Sarah E Ray,Robert Reiner,Nafis Sadat,Haniye Sadat Sajadi,João Vasco Santos,Abdur Razzaque Sarker,Benn Sartorius,Maheswar Satpathy,Miloje Savic,Matthew T. Schneider,Sadaf G. Sepanlou,Masood Ali Shaikh,Mehdi Sharif,Jun She,Aziz Sheikh,Mekonnen Sisay,Samir Soneji,Moslem Soofi,Henok Tadesse,Tianchan Tao,Tara Templin,Azeb Gebresilassie Tesema,Subash Thapa,Alan J Thomson,Ruoyan Tobe-Gai,Roman Topor-Madry,Bach Xuan Tran,Khanh Bao Tran,Tung Thanh Tran,Eduardo A. Undurraga,Tommi Vasankari,Francesco Saverio Violante,Tissa Wijeratne,Gelin Xu,Naohiro Yonemoto,Mustafa Z. Younis,Chuanhua Yu,Maysaa El Sayed Zaki,Lei Zhou,Bianca S. Zlavog,Christopher J L Murray +139 more
TL;DR: In this article, the authors developed improved estimates of health spending by source, including development assistance for health, and for the first time, estimated HIV/AIDS spending on prevention and treatment and by source of funding, for 188 countries.
Journal ArticleDOI
Comparative assessment of five trials of universal HIV testing and treatment in sub‐Saharan Africa
Delphine Perriat,Laura B. Balzer,Laura B. Balzer,Richard J. Hayes,Shahin Lockman,Shahin Lockman,Fiona J Walsh,Helen Ayles,Sian Floyd,Diane V. Havlir,Moses R. Kamya,Refeletswe Lebelonyane,Lisa A. Mills,Velephi Okello,Maya L. Petersen,Deenan Pillay,Kalpana Sabapathy,Kathleen E. Wirth,Joanna Orne-Gliemann,François Dabis +19 more
TL;DR: Five community‐based trials have been implemented in sub‐Saharan Africa to measure the effects of various UTT strategies at population level and the contexts, research methodologies, intervention packages, themes explored, evolution of study designs and interventions related to each of these five UTT trials are described.
Journal ArticleDOI
Can differentiated care models solve the crisis in HIV treatment financing? Analysis of prospects for 38 countries in sub-Saharan Africa.
TL;DR: This work model the potential reduction in facility‐level costs and number of health workers needed when implementing two types of DCMs while attempting to reach 90‐90‐90 targets in 38 sub‐Saharan African countries from 2016 to 2020.
Journal ArticleDOI
Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
Mark Moses,Paola Pedroza,Ranju Baral,Sabina Bloom,Jonathan C Brown,Abby Chapin,Kelly Compton,Erika Eldrenkamp,Nancy Fullman,John Everett Mumford,Vishnu Nandakumar,Katherine L. Rosettie,Nafis Sadat,Tom Shonka,Abraham D. Flaxman,Theo Vos,Christopher J L Murray,Marcia R. Weaver +17 more
TL;DR: UHC plans can be based on utilisation and unit costs of current health systems and guided by standards of utilisation of outpatient visits and inpatient admissions that achieve the highest coverage of personal health services at the lowest cost.
Journal ArticleDOI
Potential for additional government spending on HIV/AIDS in 137 low-income and middle-income countries: an economic modelling study.
Annie Haakenstad,Mark Moses,Tianchan Tao,Golsum Tsakalos,Bianca S. Zlavog,Jennifer Kates,Adam Wexler,Christopher J L Murray,Joseph L Dieleman +8 more
TL;DR: A large gap exists between available financing and the funding needed to achieve global HIV/AIDS goals, and sustained and coordinated effort across international and domestic development partners is required to end AIDS by 2030.
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