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. 2017 Jan 4;17(1):6.
doi: 10.1186/s12913-016-1962-9.

Performance-based financing for improving HIV/AIDS service delivery: a systematic review

Amitabh B Suthar  1 , Jason M Nagata  2 , Sabin Nsanzimana  3   4 , Till Bärnighausen  5   6   7 , Eyerusalem K Negussie  8 , Meg C Doherty  8
Affiliations

Performance-based financing for improving HIV/AIDS service delivery: a systematic review

Amitabh B Suthar et al. BMC Health Serv Res. .

Abstract

Background: Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines.

Methods: PubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207.

Results: Four studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported.

Conclusions: Although the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.

Keywords: AIDS; Access; Antiretroviral therapy; Efficiency; HIV; HIV testing; HIV treatment; Health financing; Quality; Service; Universal health coverage.

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Figures

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Fig. 1
Study selection
Fig. 2
Fig. 2
Effects of PBF on HIV service access and quality. *Adjusted odds ratio rather than relative risk presented. Treatment failure defined as CD4 persistently below 100 cells/mm3 after 6–12 months of ART, CD4 falls by ≥50% from on treatment peak value, and/or CD4 falls to or below pre-ART level
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References

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    1. Joint United Nations Programme on HIV and AIDS. MDG6: 15 years, 15 lessons of hope from the AIDS response. 2015. Available from: http://www.unaids.org/sites/default/files/media_asset/MDG6Report_en.pdf. [cited 24 July 2015].
    1. World Health Organization. Global update on the health sector response to HIV, 2014. 2014. Available from: http://www.who.int/iris/bitstream/10665/128494/1/9789241507585_eng.pdf. [cited 4 June 2015].
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    1. United Nations General Assembly Resolution 70/1. Transforming our World: the 2030 Agenda for Sustainable Development. 2015. Available from: http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E. [cited 4 November 2015].

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