The global Optima HIV allocative efficiency model: targeting resources in efforts to end AIDS
The global Optima HIV allocative efficiency model: targeting resources in efforts to end AIDS
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DOI：
10.1016/s2352-3018(18)30024-9
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发表时间：
2018-04-01
期刊：
影响因子：
16.1
通讯作者：
Wilson, David P.
中科院分区：
文献类型：
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作者：
Kelly, Sherrie L.;Martin-Hughes, Rowan;Wilson, David P.
为实现到2030年消除艾滋病的目标，应经济有效地分配艾滋病毒资源。我们使用Optima HIV模型来估计如何重新定位全球HIV资源以实现最大的流行病学效果，以及到2030年可以避免多少新的感染。（包括人口、流行病学、行为、方案和支出数据），从2000年1月1日至2015年12月31日，44个国家，捕获了全世界80%的艾滋病毒感染者。这些数据被用来在Optima艾滋病毒框架内对国家以下各级和国家一级的单独模型进行参数化。为了估计国家以下、国家、区域和全球各级的最佳资源分配，我们使用了一种自适应随机下降优化算法，并结合每个国家每个方案的流行病模型和成本函数。最佳分配分析是在国际艾滋病毒基金对每个国家保持不变的情况下进行的，并通过在国家之间重新分配这些基金。结果如果没有额外的资金，我们估计，如果各国要在2016年至2030年期间最佳分配其艾滋病毒资源，（不确定性范围390万-1400万）新感染可以避免，代表发病率降低26%（不确定性范围13-50%）。在国家之间重新分配国际资金可以避免另外190万例感染，这意味着总体发病率降低33%（不确定性范围为20-58%）。为了将艾滋病毒发病率比2010年降低90%，我们估计，到2030年，需要将目前的年度资金增加三倍以上。最佳资源重新分配的最常见优先事项是扩大针对每种环境中风险最大的关键人群的治疗和预防方案。其他艾滋病毒方案的优先次序取决于流行病学和在每个环境中提供服务的成本效益以及资源的可用性。解释通过更好地针对国际和国家艾滋病毒资源，进一步减少全球艾滋病毒发病率是可能的。
Background To move towards ending AIDS by 2030, HIV resources should be allocated cost-effectively. We used the Optima HIV model to estimate how global HIV resources could be retargeted for greatest epidemiological effect and how many additional new infections could be averted by 2030.Methods We collated standard data used in country modelling exercises (including demographic, epidemiological, behavioural, programmatic, and expenditure data) from Jan 1, 2000, to Dec 31, 2015 for 44 countries, capturing 80% of people living with HIV worldwide. These data were used to parameterise separate subnational and national models within the Optima HIV framework. To estimate optimal resource allocation at subnational, national, regional, and global levels, we used an adaptive stochastic descent optimisation algorithm in combination with the epidemic models and cost functions for each programme in each country. Optimal allocation analyses were done with international HIV funds remaining the same to each country and by redistributing these funds between countries.Findings Without additional funding, if countries were to optimally allocate their HIV resources from 2016 to 2030, we estimate that an additional 7.4 million (uncertainty range 3.9 million-14.0 million) new infections could be averted, representing a 26% (uncertainty range 13-50%) incidence reduction. Redistribution of international funds between countries could avert a further 1.9 million infections, which represents a 33% (uncertainty range 20-58%) incidence reduction overall. To reduce HIV incidence by 90% relative to 2010, we estimate that more than a three-fold increase of current annual funds will be necessary until 2030. The most common priorities for optimal resource reallocation are to scale up treatment and prevention programmes targeting key populations at greatest risk in each setting. Prioritisation of other HIV programmes depends on the epidemiology and cost-effectiveness of service delivery in each setting as well as resource availability.Interpretation Further reductions in global HIV incidence are possible through improved targeting of international and national HIV resources.