20th International AIDS Conference - Melbourne, Australia


THPE396 Poster Exhibition

Investment case for an evolving IDU epidemic: national goals application in Ukraine

Presented by Arin Dutta (United States).

N. Perales1, A. Dutta1, O. Semerik2, O. Balakireva3

1Health Policy Project, Futures Group, Washington, United States, 2Health Policy Project, Futures Group, Kiev, Ukraine, 3Institute for Economics and Forecasting of the National Academy of Sciences of Ukraine, Kiev, Ukraine

Background: Once dominated by IDU infections, the adult HIV incidence in Ukraine is now increasing among other key populations and the national prevention strategy must adapt. In this context, the USAID-supported Health Policy Project partnered with State Service of Ukraine on HIV/AIDS and the Institute for Economy and Forecasting in July 2013 to analyze the cost and effectiveness of HIV prevention over 2014-2018. The analysis aimed to inform the National AIDS Programme (NAP) 2014-2018.
Methods: We applied the Goals mathematical model to examine the effects of scaling up treatment, harm reduction, and other behavioral interventions on incidence. We also developed an Excel-based model to estimate the implementation cost. Recent Ukraine-specific epidemiological, behavioral, demographic, and cost data were obtained from the Ministry of Health and other secondary sources.
We examined four scenarios for coverage scale-up:
1. Maintaining 2012 treatment, care, and prevention coverage (Constant 2012)
2. Increasing coverage to targets proposed for the NAP (NAP 2014-2018)
3. Achievement of universal access (UA) for all prevention interventions under NAP (NAP with UA)
4. Assuming Global Fund (GF) grants are not renewed: discontinuation of NAP prevention interventions for key populations currently implemented with GF funding (GF Risk).
Scenario 1 is the baseline for all comparative analyses.
Results: The scale-up of ART services under Scenarios 2-4 would avert 39,445 deaths compared with Scenario 1. Implementing the NAP 2014-2018 scenario would require US$ 776 million over 2014-2018 and avert 17,541 infections. In contrast, implementing Scenario 3 or 4 would avert 29,032 or 10,999 infections, respectively. The more ambitious scale-up under Scenario 3 would incur the highest cost, US$ 889 million, but achieve the lowest incremental cost effectiveness ratio (ICER), US$ 12,318 per infection averted. In GF Risk scenario, overall investment falls to US$ 729 million, and the ICER would rise to US$ 18,959 per infection averted.
Conclusions: NAP with UA for prevention is the most cost-effective prevention strategy, suggesting additional investment in Ukraine would be rational and could save lives. Non-renewal of Global Fund support for key prevention interventions in Ukraine would substantially weaken the efficiency and effectiveness of its HIV response, and requires an urgent resource mobilization strategy.

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