Projects

Optima HIV: maximising the impact of HIV funding

What is the context?

HIV, the virus that causes AIDS, is one of the world’s most serious health and development challenges. There were approximately 36.7 million people worldwide living with HIV/AIDS at the end of 2015; 1.8 million of these were children (<15 years old).

Over the course of the HIV epidemic, the scale of the global response has been unprecedented. Since 2002, an estimated US$80.3 billion in development assistance for HIV programs has been disbursed in over 100 lower-income countries.

However, the trend in funding over the past seven years has been almost flat. Development assistance for HIV in 2015 totalled US$7.5 billion, which represented a 13 percent decrease from 2014 levels (the first funding decrease in five years) and brought the total amount of funding back to 2008 levels.

Thus, the question of how to get the most out of the available HIV funding is more essential now than ever before. Across the world, governments and funding bodies are facing the challenge of how to distribute their limited funds to achieve the greatest health outcomes, while also addressing issues of equity, access and protection against financial catastrophe.

What does the project aim to do?

The Optima HIV model was developed to help governments and funding bodies understand how to best allocate their funds in order to get the best health outcomes. It was designed and developed by the Optima Consortium for Decision Science (the Optima Consortium) with technical inputs and guidance from the World Bank.

The tool itself is based on a compartmental model of HIV transmission and disease progression, and is capable of producing estimates of epidemic trends, resource needs, and the impact and cost-effectiveness of HIV responses. Furthermore, it can estimate the allocation of resources across programs that best addresses national HIV targets whilst considering various logistic, political, and ethical constraints.

The Optima HIV project has been underway for almost 10 years, and has undergone several phases. The initial phase of the Optima HIV project involved developing epidemic and economic modeling frameworks via the creation of country-specific models for Indonesia, Cambodia, Papua New Guinea, the Philippines, and Australia. This was followed by a phase of substantial technical advancement based on the lessons learned from the first phase, accompanied by an expanded vision that included developing a state-of-the-art, web-based graphical user interface for the model, building capacity around the world to use the new model and interface, and facilitating its widespread use in each region of the world. At the conclusion of this phase, the model was launched as a public good, accessible at hiv.optimamodel.com.

Since its inception, the Optima HIV software has since been used in around 40 countries in applications with Ministries of Health for guiding target setting, investment cases for operations of national strategic plans, and in grant applications. It has also been applied to over 50 countries in research studies as well as inform the ASEAN Health Ministers Summit, Hanoi 2015; and the United Nations General Assembly 2015.

Currently, the Optima HIV team is engaged in supporting the World Bank with their in-country HIV allocative efficiency analyses, supporting the Presidents Emergency Fund for AIDS Relief (PEPFAR) in understanding the impact of their investments, and conducting ongoing research studies into HIV epidemics and responses around the world.

Timeline

Current - June 2019.

Outcomes

Case study: Applying Decision Science to Inform HIV Resource Allocation in Belarus

Belarus experiences a concentrated but rapidly growing HIV epidemic, in which annual new HIV infections doubled between 2010-2015 and reached 5,300 in 2015.

In preparation of its new HIV strategy for 2016-2020, Belarus in collaboration with international partners conducted an allocative efficiency analysis using Optima HIV, a mathematical HIV epidemic model with an integrated program and economic analysis framework and resource optimisation feature.

The study made three essential recommendations:

  • focus on, double budget allocations to, and scale up antiretroviral therapy (ART) scale up prevention for key populations—particularly harm reduction for people who inject drugs
  • explore technical efficiencies, review unit costs and spending on management and other cross-cutting costs.

The Government of Belarus took these recommendations into account in its revised National HIV/AIDS Prevention Program (NAP) 2016-2020 by: - Increasing allocations to ART from 15 percent to 31 percent of HIV budgets - Increasing allocations to programs for key populations from 12 percent to 29 percent of HIV budgets - Reducing management and cross-cutting expenses from 52 percent to 34 percent of HIV budgets.

A second analysis was carried out to assess the effect of these changes in budget allocations. This analysis suggests that the improved budget allocation in the new national programme will avert an additional 3,200 new HIV infections and 1,800 AIDS deaths between 2016-2018 and, if sustained, avert 25,000 new infections and 13,000 AIDS deaths by 2030 – a reduction by around a third compared to business as usual.

This case study demonstrates that application of HIV investment analytics in Belarus informed by data, expert opinion and a collaboratively conducted mathematical modelling exercise changed budget allocations, which will make substantial impacts on the HIV epidemic.

At the same time, as Belarus is faced with a growing HIV epidemic, our analysis also suggests that current investment into HIV programs is insufficient to achieve epidemic control or an end of AIDS by 2030. Additional investment and efficiency gains are required as part of a sustained HIV response to achieve more ambitious targets.

Publications

2016

2015

Collaborators

People

  • Dr Robyn Stuart
  • Dr Cliff Kerr

Organisations

  • World Bank
  • Global Fund to fight AIDS, Tuberculosis and Malaria
  • United States President’s Emergency Plan for AIDS Relief
  • HIV Modelling Consortium
  • Joint United Nations Programme on HIV/AIDS (UNAIDS)
  • United Nations Development Programme (UNDP)
  • Australian Department of Foreign Affairs and Trade
  • University College of London
  • University of Bern
  • University of Copenhagen
  • University of Geneva

Funding

  • The World Bank
  • The United States President’s Emergency Plan for AIDS Relief
  • The National Health and Medical Research Council

Health Issue

Contact Details

For any general enquiries relating to this project, please contact:

Professor David Wilson

Head of Infectious Disease Modelling

Email

david.wilson@burnet.edu.au