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The size and distribution of key populations at greater risk of HIV in Pakistan: implications for resource allocation for scaling up HIV prevention programmes.

Emmanuel F, Thompson LH, Salim M, Akhtar N, Reza TE, Hafeez H, Ahmed S, Blanchard JF - Sex Transm Infect (2013)

Bottom Line: Cities were prioritised according to key population size.The total cost varies according to the local needs and the purchasing power of the local currency.By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Public Health, University of Manitoba, , Winnipeg, Manitoba, Canada.

ABSTRACT

Background: With competing interests, limited funding and a socially conservative context, there are many barriers to implementing evidence-informed HIV prevention programmes for sex workers and injection drug users in Pakistan. Meanwhile, the HIV prevalence is increasing among these populations across Pakistan. We sought to propose and describe an approach to resource allocation which would maximise the impact and allocative efficiency of HIV prevention programmes.

Methods: Programme performance reports were used to assess current resource allocation. Population size estimates derived from mapping conducted in 2011 among injection drug users and hijra, male and female sex workers and programme costs per person documented from programmes in the province of Sindh and also in India were used to estimate the cost to deliver services to 80% of these key population members across Pakistan. Cities were prioritised according to key population size.

Results: To achieve 80% population coverage, HIV prevention programmes should be implemented in 10 major cities across Pakistan for a total annual operating cost of approximately US$3.5 million, which is much less than current annual expenditures. The total cost varies according to the local needs and the purchasing power of the local currency.

Conclusions: By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.

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Number of reported HIV cases in Pakistan, and Pakistan Government's response to HIV from 1985 to 2011.
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SEXTRANS2013051017F2: Number of reported HIV cases in Pakistan, and Pakistan Government's response to HIV from 1985 to 2011.

Mentions: National-level HIV prevention priorities, resource allocation and implementation strategies are described in the strategic plans prepared and published by the National AIDS Control Program (NACP), and the progress reports to the United Nations General Assembly Special Session on HIV/AIDS.11–14 Since 1986, the national response to HIV/AIDS in Pakistan (figure 2) has been led by NACP, with Provincial AIDS Control Programs (PACPs) largely responsible for implementation, much of which takes place through non-governmental organisations (NGOs).1516 Coordinated global efforts for HIV prevention prompted the Government of Pakistan to develop its 5-year National Strategic Framework (NSF-I) with UNAIDS support in 2001, which set priorities and aimed to establish a multisectoral response.17 This led to the Enhanced HIV/AIDS Control Program (EHACP) for a 5 year period with financial support from the World Bank, the UK Department for International Development (DFID), and the Canadian International Development Agency (CIDA), with an overall focus on HIV prevention among key populations. The national response was reviewed in 2006, and the Second National Strategic Framework (NSF-II) was developed for 2007–201114 with a total budget of US$99.4 million from the World Bank, DFID and the Government of Pakistan described in the Planning Commission Document 1 (PC-1) of the EHACP. PC-1s describe the programme plan and budget for the subsequent 5 years, and are approved by the executive committee of the National Economic Council (Pakistan). Pakistan also received funding from The Global Fund to Fight AIDS, tuberculosis and malaria to scale up prevention and treatment, care and support services for IDUs. Due to devolution of the ministry of health, the provinces are developing their own HIV prevention strategies which will form the Pakistan AIDS Strategy (PAS-III 2012–2016).11


The size and distribution of key populations at greater risk of HIV in Pakistan: implications for resource allocation for scaling up HIV prevention programmes.

Emmanuel F, Thompson LH, Salim M, Akhtar N, Reza TE, Hafeez H, Ahmed S, Blanchard JF - Sex Transm Infect (2013)

Number of reported HIV cases in Pakistan, and Pakistan Government's response to HIV from 1985 to 2011.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756450&req=5

SEXTRANS2013051017F2: Number of reported HIV cases in Pakistan, and Pakistan Government's response to HIV from 1985 to 2011.
Mentions: National-level HIV prevention priorities, resource allocation and implementation strategies are described in the strategic plans prepared and published by the National AIDS Control Program (NACP), and the progress reports to the United Nations General Assembly Special Session on HIV/AIDS.11–14 Since 1986, the national response to HIV/AIDS in Pakistan (figure 2) has been led by NACP, with Provincial AIDS Control Programs (PACPs) largely responsible for implementation, much of which takes place through non-governmental organisations (NGOs).1516 Coordinated global efforts for HIV prevention prompted the Government of Pakistan to develop its 5-year National Strategic Framework (NSF-I) with UNAIDS support in 2001, which set priorities and aimed to establish a multisectoral response.17 This led to the Enhanced HIV/AIDS Control Program (EHACP) for a 5 year period with financial support from the World Bank, the UK Department for International Development (DFID), and the Canadian International Development Agency (CIDA), with an overall focus on HIV prevention among key populations. The national response was reviewed in 2006, and the Second National Strategic Framework (NSF-II) was developed for 2007–201114 with a total budget of US$99.4 million from the World Bank, DFID and the Government of Pakistan described in the Planning Commission Document 1 (PC-1) of the EHACP. PC-1s describe the programme plan and budget for the subsequent 5 years, and are approved by the executive committee of the National Economic Council (Pakistan). Pakistan also received funding from The Global Fund to Fight AIDS, tuberculosis and malaria to scale up prevention and treatment, care and support services for IDUs. Due to devolution of the ministry of health, the provinces are developing their own HIV prevention strategies which will form the Pakistan AIDS Strategy (PAS-III 2012–2016).11

Bottom Line: Cities were prioritised according to key population size.The total cost varies according to the local needs and the purchasing power of the local currency.By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Public Health, University of Manitoba, , Winnipeg, Manitoba, Canada.

ABSTRACT

Background: With competing interests, limited funding and a socially conservative context, there are many barriers to implementing evidence-informed HIV prevention programmes for sex workers and injection drug users in Pakistan. Meanwhile, the HIV prevalence is increasing among these populations across Pakistan. We sought to propose and describe an approach to resource allocation which would maximise the impact and allocative efficiency of HIV prevention programmes.

Methods: Programme performance reports were used to assess current resource allocation. Population size estimates derived from mapping conducted in 2011 among injection drug users and hijra, male and female sex workers and programme costs per person documented from programmes in the province of Sindh and also in India were used to estimate the cost to deliver services to 80% of these key population members across Pakistan. Cities were prioritised according to key population size.

Results: To achieve 80% population coverage, HIV prevention programmes should be implemented in 10 major cities across Pakistan for a total annual operating cost of approximately US$3.5 million, which is much less than current annual expenditures. The total cost varies according to the local needs and the purchasing power of the local currency.

Conclusions: By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.

Show MeSH