Reorienting the HIV response in Niger toward sex work interventions: from better evidence to targeted and expanded practice

Journal of Acquired Immune Deficiency Syndromes : JAIDS
Nicole FraserMarelize Gorgens

Abstract

Niger's low-burden, sex-work-driven HIV epidemic is situated in a context of high economic and demographic growth. Resource availability of HIV/AIDS has been decreasing recently. In 2007-2012, only 1% of HIV expenditure was for sex work interventions, but an estimated 37% of HIV incidence was directly linked to sex work in 2012. The Government of Niger requested assistance to determine an efficient allocation of its HIV resources and to strengthen HIV programming for sex workers. Optima, an integrated epidemiologic and optimization tool, was applied using local HIV epidemic, demographic, programmatic, expenditure, and cost data. A mathematical optimization algorithm was used to determine the best resource allocation for minimizing HIV incidence and disability-adjusted life years (DALYs) over 10 years. Efficient allocation of the available HIV resources, to minimize incidence and DALYs, would increase expenditure for sex work interventions from 1% to 4%-5%, almost double expenditure for antiretroviral treatment and for the prevention of mother-to-child transmission, and reduce expenditure for HIV programs focusing on the general population. Such an investment could prevent an additional 12% of new infections despite a budget of ...Continue Reading

Citations

Mar 2, 2016·Journal of the International AIDS Society·Andrew J ShattockRichard T Gray
Apr 20, 2016·Global Public Health·David HoosKarl-Lorenz Dehne
Mar 17, 2018·PloS One·Cliff C KerrDavid P Wilson
Jan 17, 2019·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Mathieu Maheu-GirouxMichel Alary
Feb 28, 2015·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Tisha WheelerGina Dallabetta
Nov 1, 2020·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Anton L V Avanceña, David W Hutton

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