Estimating the resource needs of scaling-up HIV/AIDS and tuberculosis interventions in sub-Saharan Africa: A systematic review for national policy makers and planners

Royal Tropical Institute, Amsterdam, The Netherlands.
Health Policy (Impact Factor: 1.91). 12/2006; 79(1):1-15. DOI: 10.1016/j.healthpol.2005.11.005
Source: PubMed


Considerable effort has been made to estimate the global resource requirements of scaling-up HIV/AIDS and tuberculosis (TB) interventions. There are currently several medium- and long-term global estimates available. Comprehensive country specific estimates are now urgently needed to ensure the successful scaling-up of these services. This paper reviews evidence on the global resource requirements of scaling-up HIV/AIDS and TB interventions. The purpose of this review is to summarise and critically appraise the methods used in the global estimates and to identify remaining knowledge gaps, particularly those relevant to country level estimation. This review found that the estimates of global resource requirements provide sound methodological guidance for countries on the basic steps to follow. However, there are still many areas that require further development or evidence. These include the following. Firstly, the methods used to assess the capacity to scale up HIV/AIDS and TB services need to be further refined. In particular countries need simple methods to assess human resource capacity. Secondly, investments need to be made to improve country level data on the costs and effectiveness of HIV/AIDS and TB services. In particular efforts should be focused on producing standardised unit costs for each intervention by country, which reflect the reality of domestic resource use. Thirdly, simple costing models, which appropriately integrate systems costs need to be developed for use at the country level. Finally, resources needs estimation needs to be embedded by countries in multi-sectoral expenditure planning processes. Countries and global agencies will continue to need estimates for different purposes at different times. Therefore attention should move away from specific estimates, to the longer term aim of building capacity at the country level, supported by global agencies. This will be of mutual benefit. Those making national resource estimates can learn from the experience of global estimation. Concurrently, global resource estimates can build on the evidence emerging from improved national resource estimates.

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    • "In order to alleviate the financial burden borne by TB patients, policy makers should consider incorporating policies to support patients receiving TB treatment into general financing and risk-pooling strategies, such as tax-based or social insurance systems as used by many developed and, increasingly, developing economies. While in some settings strategies aimed at reducing patient costs incurred when utilizing healthcare may be feared to lead to increases in demand for healthcare exceeding the underlying need, in many developing countries like those in sub-Saharan Africa, healthcare demand is currently far below need, including for the priority diseases TB and HIV, so that financial and non-financial support for healthcare seeking is likely to contribute substantially to improving population health [70,71]. In addition to the direct benefits to the treated patient, TB treatment also reduces onward transmission of the disease in the community. "
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    ABSTRACT: Background Tuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. Methods PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$). Results Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. Conclusion TB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment and care, both within and outside of Directly Observed Therapy Short-course (DOTS) programs. For many households, TB treatment and care-related costs were considered to be catastrophic because the patient costs incurred commonly amounted to 10% or more of per capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.
    BMC Public Health 11/2012; 12(1):980. DOI:10.1186/1471-2458-12-980 · 2.26 Impact Factor
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    • "The health systems in SSA lack human resources to face the increasing needs to care for people living with HIV (Vassall & Compernolle, 2006) and the World Health Organization (WHO) has since 1974 acknowledged the importance of traditional health practitioners. WHO has also suggested these practitioners become more involved in standard HIV care. "
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    ABSTRACT: The objective of this study was to explore the influence of traditional medicine and religion on discontinuation of antiretroviral therapy (ART) in one of Africa's largest informal urban settlement, Kibera, in Nairobi, Kenya. Semi-structured face-to-face interviews were conducted with 20 patients discontinuing the African Medical and Research Foundation (AMREF) ART program in Kibera due to issues related to traditional medicine and religion. Traditional medicine and religion remain important in many people's lives after ART initiation, but these issues are rarely addressed in a positive way during ART counseling. Many patients found traditional medicine and their religious beliefs to be in conflict with clinic treatment advice. Patients described a decisional process, prior to the actual drop-out from the ART program that involved a trigger event, usually a specific religious event, or a meeting with someone using traditional medicine that influenced them to take the decision to stop ART. Discontinuation of ART could be reduced if ART providers acknowledged and addressed the importance of religious issues and traditional medicine in the lives of patients, especially in similar resource-poor settings. Telling patients not to mix ART and traditional medicine appeared counter-productive in this setting. Introducing an open discussion around religious beliefs and the pros and cons of traditional medicine as part of standard counseling, may prevent drop-out from ART when side effects or opportunistic infections occur.
    AIDS Care 03/2011; 23(7):851-8. DOI:10.1080/09540121.2010.534432 · 1.60 Impact Factor
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    • "This may lead to a successful small project but can inadvertently undermine the long-term goals of capacity strengthening and institution building. This has been especially true in the context of the HIV/AIDS epidemic in developing countries [2,11,13,14]. This problem has now been recognized and acknowledged by the donor community and the countries, which increasingly plan to better coordinate aid to support national health systems rather than focusing exclusively on disease-specific priorities[15,16]. "
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    ABSTRACT: Increased funding for global human immunodeficiency virus prevention and control in developing countries has created both a challenge and an opportunity for achieving long-term global health goals. This paper describes a programme in Zimbabwe aimed at responding more effectively to the HIV/AIDS epidemic by reinforcing a critical competence-based training institution and producing public health leaders. The programme used new HIV/AIDS programme-specific funds to build on the assets of a local education institution to strengthen and expand the general public health leadership capacity in Zimbabwe, simultaneously ensuring that they were trained in HIV interventions. The programme increased both numbers of graduates and retention of faculty. The expanded HIV/AIDS curriculum was associated with a substantial increase in trainee projects related to HIV. The increased number of public health professionals has led to a number of practically trained persons working in public health leadership positions in the ministry, including in HIV/AIDS programmes. Investment of a modest proportion of new HIV/AIDS resources in targeted public health leadership training programmes can assist in building capacity to lead and manage national HIV and other public health programmes.
    Human Resources for Health 09/2009; 7(1):69. DOI:10.1186/1478-4491-7-69 · 1.83 Impact Factor
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