Designing equitable antiretroviral allocation strategies in resource-constrained countries
Designing equitable antiretroviral allocation strategies in resource-constrained countries
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DOI：
10.1371/journal.pmed.0020050
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发表时间：
2005-02-01
期刊：
影响因子：
15.8
通讯作者：
Blower, SM
中科院分区：
文献类型：
--
作者：
Wilson, DP;Blower, SM
背景最近，全球承诺扩大发展中国家获得抗逆转录病毒药物(ARV)的机会。然而，在许多资源有限的国家，需要治疗的艾滋病毒感染者的数量将远远超过抗逆转录病毒药物的供应，只有有限数量的卫生保健设施可用于抗逆转录病毒药物的分发。决定如何在HCF之间分配有限的抗逆转录病毒药物供应将是极其困难的。资源分配的决策可以基于许多流行病学、伦理学或优先治疗的标准。方法和结果在这里，我们使用运筹学技术，我们展示了如何确定在HCF之间分配抗逆转录病毒药物的最优策略，以满足每个感染艾滋病毒的人都有平等的机会接受抗逆转录病毒药物的公平标准。我们提出了一个新的空间数学模型，该模型包含了治疗可及性的异质性。我们展示了如何使用我们的理论框架，结合公平目标函数，为资源受限地区的抗逆转录病毒药物确定最优公平分配策略(OEA)。我们的公平目标职能使我们能够在获得保健方面适用平等原则。我们使用南非政府设计的详细的ARV推广计划中的数据来确定夸祖鲁-纳塔尔省的OEAS。我们确定了夸祖鲁-纳塔尔省的最低生活津贴，并将其与其他两种抗逆转录病毒药物分配策略进行了比较：(I)仅向德班(夸祖鲁-纳塔尔省最大的城市)分配抗逆转录病毒药物；(Ii)将抗逆转录病毒药物平均分配给所有可用的母国。此外，我们将这些想法与南非政府目前的分配计划(基于向17个母国分配抗逆转录病毒药物)进行了比较。我们表明，与这三种抗逆转录病毒药物分配策略相比，我们的OEAS显著提高了治疗可获得性的公平性。我们还量化了围绕每个HCF的集水区的大小，以及用于抗逆转录病毒分布的HCF的数量，如何改变OEAS和实现治疗可获得性公平的可能性。我们计算得出，为了在夸祖鲁-纳塔尔实现HIV感染者最大程度的治疗公平，抗逆转录病毒药物应该分配给54个HCF，每个HCF应该服务于40到60公里的集水区。结论与其他分配策略相比，我们的OEAS将大大提高治疗可获得性的平等性。此外，我们的OEAS与目前计划的战略有很大的不同。我们建议使用我们的新方法为资源受限的国家设计最优的抗逆转录病毒药物分配策略。
Background Recently, a global commitment has been made to expand access to antiretrovirals (ARVs) in the developing world. However, in many resource-constrained countries the number of individuals infected with HIV in need of treatment will far exceed the supply of ARVs, and only a limited number of health-care facilities (HCFs) will be available for ARV distribution. Deciding how to allocate the limited supply of ARV's among HCFs will be extremely difficult. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria.Methods and Findings Here we use operations research techniques, and we show how to determine the optimal strategy for allocating ARVs among HCFs in order to satisfy the equitable criterion that each individual infected with HIV has an equal chance of receiving ARVs. We present a novel spatial mathematical model that includes heterogeneity in treatment accessibility. We show how to use our theoretical framework, in conjunction with an equity objective function, to determine an optimal equitable allocation strategy (OEAS) for ARVs in resource-constrained regions. Our equity objective function enables us to apply the egalitarian principle of equity with respect to access to health care. We use data from the detailed ARV rollout plan designed by the government of South Africa to determine an OEAS for the province of KwaZulu-Natal. We determine the OEAS for KwaZulu-Natal, and we then compare this OEAS with two other ARV allocation strategies: (i) allocating ARVs only to Durban (the largest urban city in KwaZulu-Natal province) and (ii) allocating ARVs equally to all available HCFs. In addition, we compare the IDEAS to the current allocation plan of the South African government (which is based upon allocating ARVs to 17 HCFs). We show that our OEAS significantly improves equity in treatment accessibility in comparison with these three ARV allocation strategies. We also quantify how the size of the catchment region surrounding each HCF, and the number of HCFs utilized for ARV distribution, alters the OEAS and the probability of achieving equity in treatment accessibility. We calculate that in order to achieve the greatest degree of treatment equity for individuals with HIV in KwaZulu-Natal, the ARVs should be allocated to 54 HCFs and each HCF should serve a catchment region of 40 to 60 km.Conclusion Our OEAS would substantially improve equality in treatment accessibility in comparison with other allocation strategies. Furthermore, our OEAS is extremely different from the currently planned strategy. We suggest that our novel methodology be used to design optimal ARV allocation strategies for resource-constrained countries.