The World Health Organization’s (WHO) Member States made it a point to develop health financing systems to act as a forerunner for universal health coverage in 2011 by teaming up with countries to review, develop, and implement effective financial strategies that could help reach global health goals. A study published in the Bulletin of the World Health Organization has found that integrating HIV services, such as achieving lower unit-costs per patient with other health care services like ones for tuberculosis, could help optimize the funds contributed to these programs.

"HIV is one field where there seems to be a scientific consensus not only about what works but also about the most efficient ways to delivery health care," Jeremy Lauer, a health economist in the department of Health Systems Governance and Financing at WHO, said in a statement. "Economic evaluation of other health programmes also shows strong evidence from an economic, programmatic and ethical perspective to support comprehensive delivery models — ones that cover the complete spectrum of prevention, detection, treatment and care. When you have comprehensive care for managing chronic conditions like HIV/AIDS — better prevention means less treatment, and early detection and effective treatment lead to better health outcomes for the patients.”

Researchers from the London School of Hygiene and Tropical Medicine and the Joint United Nations Programme on HIV/AIDS (UNAIDS) assessed 82 economic studies of HIV services in 35 low and middle-income countries such as Bangladesh, Brazil, Cameroon, Ecuador, Ghana, Haiti, India, Mexico, and Zimbabwe. Technical efficiency and potential cost savings were analyzed in the six program areas of UNAIDS, which included antiretroviral therapy, counseling, and testing, targeting at-risk populations such as sex workers and intravenous drug users, condom distribution and social marketing, voluntary male circumcision, programs to prevent HIV infection in children and mother, and behavior-change communication targeting both young adults and the general population.

Overall, the cost of antiretroviral treatment per patient and the cost of HIV prevention for key populations plummeted as the number of patients got higher. Findings revealed that integrating two or more of these HIV services could go a long way in improving their effectiveness. By integrating program areas like tuberculosis and HIV services, researchers were able to increase their impact while enhancing the use of funds and clinical staff-time. The research team also highlighted a recent study in India where support costs for the delivery of HIV services can climb to a third of the total cost of HIV programs. Potential efficiency gains can be made by improving the organization of support for these services.

"We found that the HIV services that reached high volumes of patients had much lower costs than those serving far fewer patients, but the likelihood of loss to follow-up – when these patient volumes are high – can be greater and is a key concern," said co-author Anna Vassall, a senior lecturer in health economics at the London School of Hygiene and Tropical Medicine. "It's also important that increases in efficiency, by providing services in larger facilities, do not lead to increased payments for patients trying to access those services. More action and research is needed to help HIV programmes identify the best ways to improve efficiency, while at the same time ensuring that core HIV services delivered are of a high quality.”

To help pave the way for universal health coverage, the WHO is in the process of revising its cost-effectiveness estimates for 20 diseases, risk factors, and causes of injury, including HIV infection. Experts have also made progress in the number of HIV patients in low and middle-income countries who are receiving prevention and treatment services. As of 2012, approximately 9.7 million people in low- and middle-incomes countries were on antiretroviral treatment, compared to less than 50,000 in sub-Saharan Africa during the early 2000s. However, that only covers 34 percent of the 28.6 million people who are currently eligible for antiretroviral therapy.

Source: Siapka M, Remme M, Vassall A, et al. Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries. Bulletin of the World Health Organization. 2014.