INTERNATIONAL AIDS AND ECONOMICS NETWORK AND THE

LATEST RESEARCH IN THE ECONOMICS OF AIDS

Steven Forsythe, PhDHealth EconomistPresident of the International AIDS Economics NetworkFutures Institute

BACKGROUND OF IAEN

• 21 year old network dedicated to economists and policymakers working in the field of HIV/AIDS

• Has provided face-to-face meetings prior to IAS since 2000

• Operates a LinkedIn group since 2010 (International AIDS Economics Network Group)• Currently over 5,000 members

BILL AND MELINDA GATES FOUNDATION GRANT TO IAEN

BMGF 3 year grant has 3 objectives:• Build capacity in 4 African countries (Zambia, Tanzania, Malawi and

Uganda)• Fund special economic studies in 6 countries (Zambia, Tanzania,

Malawi, Uganda, Kenya, South Africa)• Disseminate globally information about AIDS and economics

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Resources People On Treatment New Infections

International Commitments to AIDS

RELEVANT TOPICS AT IAEN• Efficiency and Effectiveness (7)

• Financing (4)

• Sustainability and Investment Case (3)

• Costing (3)

• Socioeconomic Impact (1)

TREATMENT• Routine laboratory monitoring for toxicity, as prescribed by the WHO 2013

Guidelines is particularly expensive and may not provide measurable clinical benefits. - Charles Gilks, University of Queensland

• Why the 2013 WHO treatment guidelines may reduce the need for human resources. – Samantha Diamond, CHAI

• Why are countries such as Mexico spending so much on treatment? – Claire Chaumont, INSP

CIRCUMCISION• It makes sense to target by age and in some cases by subnational level.

The most cost-effective age to circumcise is 15-29 or 15-34 in Sub-Saharan Africa. – Katharine Kripke, Futures Institute

• Early infant male circumcision in Zimbabwe is cheaper for AccuCirc ($52) than for Mogen Clamp ($58). It is also much cheaper when performed by a nurse ($38) rather than a doctor ($52) - Karin Hatzold, PSI

• “Free” male circumcision remains too expensive for many men in Lesotho and Namibia. – Tigistu Adamu, JHPIEGO

COSTING• Eastern European/Central Asian countries face rapid

reductions in international resources for harm reduction. A barrier to replacing these resources is the lack of information about the cost of effective harm reduction services. - Danielle Parsons, APMGlobal Health

COST-EFFECTIVENESS• The cost per infection averted in Zimbabwe range between $335 and $538. A

combined community and health facility approach has the potential to improve access and retention across the PMTCT cascade. - Ravikanthi Rapiti, Population Council.

• We know much more now than a decade ago about unit costs and cost drivers. We need to be able to continue work in technical efficiencies with a particular focus on not just research, but also policy change. – Marelize Gorgens, World Bank

• An analysis of MSM in Mexico revealed which interventions are effective at changing behaviors and which interventions are not. – Sergio Bautista, INSP

• The economic consequences of different HIV interventions can vary significantly. The example of male circumcision was cited as an intervention which can have very positive long term economic consequences on a country. – Markus Haacker

FINANCING• Donor government funding commitments to address HIV in

low- and middle-income countries fell in 2013 by 8% - Jennifer Kates, Kaiser Family Foundation

• A modestly effective vaccine does reduce new infections significantly, but a highly effective vaccine is needed to get “close to zero” and to provide the cost-effectiveness needed to support broad access - Arne Näveke, International AIDS Vaccine Initiative

• Global HIV Prevention R&D Investment declined from 2012 to 2013 by 4%. This included a decline of 14% in microbicides and 3% in vaccine development. - Emily Donaldson, AVAC: Global Advocacy for HIV Prevention

SUSTAINABILITY• An analysis of Botswana’s Investment Case reveals limited

options for sustaining the country’s response. Additional investments in health system strengthening are likely to be key for Botswana to achieve universal access. – Peter Stegman, Futures Institute.

• In Bosnia, HIV/AIDS and TB are two of the only effective national programs in the country. However, they rely on funding from the Global Fund, which will be discontinued in 2015. - Dave Burrows, APMGlobal Health.

• CHAPS found that their male circumcision program in South Africa was more sustainable if given a fixed-price contract rather than a cooperative agreement. - Dino Rech, CHAPS

CONCLUSION• Data from cited studies will be available on the

www.iaen.org website and the International AIDS Economics Network group on Linkedin