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. 2019 Jun;6(6):e382-e395.
doi: 10.1016/S2352-3018(19)30038-4. Epub 2019 Apr 26.

Potential for additional government spending on HIV/AIDS in 137 low-income and middle-income countries: an economic modelling study

Annie Haakenstad  1 , Mark W Moses  2 , Tianchan Tao  2 , Golsum Tsakalos  2 , Bianca Zlavog  2 , Jennifer Kates  3 , Adam Wexler  3 , Christopher J L Murray  2 , Joseph L Dieleman  4
Affiliations

Potential for additional government spending on HIV/AIDS in 137 low-income and middle-income countries: an economic modelling study

Annie Haakenstad et al. Lancet HIV. 2019 Jun.

Abstract

Background: Between 2012 and 2016, development assistance for HIV/AIDS decreased by 20·0%; domestic financing is therefore critical to sustaining the response to HIV/AIDS. To understand whether domestic resources could fill the financing gaps created by declines in development assistance, we aimed to track spending on HIV/AIDS and estimated the potential for governments to devote additional domestic funds to HIV/AIDS.

Methods: We extracted 8589 datapoints reporting spending on HIV/AIDS. We used spatiotemporal Gaussian process regression to estimate a complete time series of spending by domestic sources (government, prepaid private, and out-of-pocket) and spending category (prevention, and care and treatment) from 2000 to 2016 for 137 low-income and middle-income countries (LMICs). Development assistance data for HIV/AIDS were from Financing Global Health 2018, and HIV/AIDS prevalence, incidence, and mortality were from the Global Burden of Disease study 2017. We used stochastic frontier analysis to estimate potential additional government spending on HIV/AIDS, which was conditional on the current government health budget and other finance, economic, and contextual factors associated with HIV/AIDS spending. All spending estimates were reported in 2018 US$.

Findings: Between 2000 and 2016, total spending on HIV/AIDS in LMICs increased from $4·0 billion (95% uncertainty interval 2·9-6·0) to $19·9 billion (15·8-26·3), spending on HIV/AIDS prevention increased from $596 million (258 million to 1·3 billion) to $3·0 billion (1·5-5·8), and spending on HIV/AIDS care and treatment increased from $1·1 billion (458·1 million to 2·2 billion) to $7·2 billion (4·3-11·8). Over this time period, the share of resources sourced from development assistance increased from 33·2% (21·3-45·0) to 46·0% (34·2-57·0). Care and treatment spending per year on antiretroviral therapy varied across countries, with an IQR of $284-2915. An additional $12·1 billion (8·4-17·5) globally could be mobilised by governments of LMICs to finance the response to HIV/AIDS. Most of these potential resources are concentrated in ten middle-income countries (Argentina, China, Colombia, India, Indonesia, Mexico, Nigeria, Russia, South Africa, and Vietnam).

Interpretation: Some governments could mobilise more domestic resources to fight HIV/AIDS, which could free up additional development assistance for many countries without this ability, including many low-income, high-prevalence countries. However, a large gap exists between available financing and the funding needed to achieve global HIV/AIDS goals, and sustained and coordinated effort across international and domestic development partners is required to end AIDS by 2030.

Funding: The Bill & Melinda Gates Foundation.

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Figures

Figure 1
Figure 1
HIV/AIDS spending by financing source and spending category over time, 2000–16 All spending estimates are in 2018 US$.
Figure 2
Figure 2
Population living with HIV/AIDS and proportion of care and treatment spending financed by development assistance, 2016
Figure 3
Figure 3
HIV/AIDS care and treatment spending per year on ART (A) and prevention spending per prevalent HIV/AIDS case (B), 2016 All spending estimates are in 2018 US$. All high-income countries, as designated by the World Bank and Global Burden of Disease, were excluded (coloured in white). ART=antiretroviral therapy. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. Isl=Islands. FSM=Federated States of Micronesia. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.
Figure 4
Figure 4
Potential government spending on HIV/AIDS relative to existing development assistance and government HIV/AIDS spending, 2016 Data are from the 15 countries that received the most development assistance for health for HIV/AIDS in 2016. Observed HIV/AIDS care and treatment spending by development assistance and domestic spending compared with the potential for additional government spending (A), and as a percentage of observed total spending on HIV/AIDS care and treatment (B). We modelled the potential for additional government spending on HIV/AIDS relative to the current government health budget, public finance, health system, and HIV/AIDS contextual factors. All spending estimates are in 2018 US$.
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