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Impact and Cost of the HIV/AIDS National Strategic Plan for Mozambique, 2015-2019--Projections with the Spectrum/Goals Model.

Korenromp EL, Gobet B, Fazito E, Lara J, Bollinger L, Stover J - PLoS ONE (2015)

Bottom Line: Additional scale-up of prevention interventions targeting high-risk groups, with improved patient retention on ART, could further reduce burden to 65,000 new infections and 51,000 HIV-related deaths in 2019.Infections averted are driven by scale-up of interventions targeting sex work (North, rising epidemic) and voluntary male circumcision (Center & South, generalized epidemics).The NSP could aim to reduce annual new HIV infections and deaths by 2019 by 30% and 40%, respectively, from 2014 levels.

View Article: PubMed Central - PubMed

Affiliation: Avenir Health, Geneva, Switzerland/Glastonbury, United States of America.

ABSTRACT

Introduction: Mozambique continues to face a severe HIV epidemic and high cost for its control, largely born by international donors. We assessed feasible targets, likely impact and costs for the 2015-2019 national strategic HIV/AIDS plan (NSP).

Methods: The HIV epidemic and response was modelled in the Spectrum/Goals/Resource Needs dynamical simulation model, separately for North/Center/South regions, fitted to antenatal clinic surveillance data, household and key risk group surveys, program statistics, and financial records. Intervention targets were defined in collaboration with the National AIDS Council, Ministry of Health, technical partners and implementing NGOs, considering existing commitments.

Results: Implementing the NSP to meet existing coverage targets would reduce annual new infections among all ages from 105,000 in 2014 to 78,000 in 2019, and reduce annual HIV/AIDS-related deaths from 80,000 to 56,000. Additional scale-up of prevention interventions targeting high-risk groups, with improved patient retention on ART, could further reduce burden to 65,000 new infections and 51,000 HIV-related deaths in 2019. Program cost would increase from US$ 273 million in 2014, to US$ 433 million in 2019 for 'Current targets', or US$ 495 million in 2019 for 'Accelerated scale-up'. The 'Accelerated scale-up' would lower cost per infection averted, due to an enhanced focus on behavioural prevention for high-risk groups. Cost and mortality impact are driven by ART, which accounts for 53% of resource needs in 2019. Infections averted are driven by scale-up of interventions targeting sex work (North, rising epidemic) and voluntary male circumcision (Center & South, generalized epidemics).

Conclusion: The NSP could aim to reduce annual new HIV infections and deaths by 2019 by 30% and 40%, respectively, from 2014 levels. Achieving incidence and mortality reductions corresponding to UNAIDS' 'Fast track' targets will require increased ART coverage and additional behavioural prevention targeting key risk groups.

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Goals model fit to historical HIV prevalence trends, 3 regions of Mozambique.Surveillance/AIM represents the statistical estimates of epidemic trends as of 2014 using the Spectrum/AIM version 5.1, beta 34.
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pone.0142908.g001: Goals model fit to historical HIV prevalence trends, 3 regions of Mozambique.Surveillance/AIM represents the statistical estimates of epidemic trends as of 2014 using the Spectrum/AIM version 5.1, beta 34.

Mentions: With the behavioural, biomedical and natural history quantifications specified (methods and S1 and S2 Files), Goals closely fitted HIV sero-prevalence trends over 1985 to 2013 for all three regions (Fig 1). To achieve this, condom usage was adjusted downward and numbers of partners adjusted upward compared to survey responses, which is justified in view of suspected social desirability bias, due to which respondents often over-report condom usage and under-report partner numbers. HIV prevalence has risen highest in Southern region (which is most developed, and neighbors South Africa, where many Mozambican workers migrate); is moderately high but with a strong reversal and ongoing decline in Center region, and lower but rising in the more remote North.


Impact and Cost of the HIV/AIDS National Strategic Plan for Mozambique, 2015-2019--Projections with the Spectrum/Goals Model.

Korenromp EL, Gobet B, Fazito E, Lara J, Bollinger L, Stover J - PLoS ONE (2015)

Goals model fit to historical HIV prevalence trends, 3 regions of Mozambique.Surveillance/AIM represents the statistical estimates of epidemic trends as of 2014 using the Spectrum/AIM version 5.1, beta 34.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643916&req=5

pone.0142908.g001: Goals model fit to historical HIV prevalence trends, 3 regions of Mozambique.Surveillance/AIM represents the statistical estimates of epidemic trends as of 2014 using the Spectrum/AIM version 5.1, beta 34.
Mentions: With the behavioural, biomedical and natural history quantifications specified (methods and S1 and S2 Files), Goals closely fitted HIV sero-prevalence trends over 1985 to 2013 for all three regions (Fig 1). To achieve this, condom usage was adjusted downward and numbers of partners adjusted upward compared to survey responses, which is justified in view of suspected social desirability bias, due to which respondents often over-report condom usage and under-report partner numbers. HIV prevalence has risen highest in Southern region (which is most developed, and neighbors South Africa, where many Mozambican workers migrate); is moderately high but with a strong reversal and ongoing decline in Center region, and lower but rising in the more remote North.

Bottom Line: Additional scale-up of prevention interventions targeting high-risk groups, with improved patient retention on ART, could further reduce burden to 65,000 new infections and 51,000 HIV-related deaths in 2019.Infections averted are driven by scale-up of interventions targeting sex work (North, rising epidemic) and voluntary male circumcision (Center & South, generalized epidemics).The NSP could aim to reduce annual new HIV infections and deaths by 2019 by 30% and 40%, respectively, from 2014 levels.

View Article: PubMed Central - PubMed

Affiliation: Avenir Health, Geneva, Switzerland/Glastonbury, United States of America.

ABSTRACT

Introduction: Mozambique continues to face a severe HIV epidemic and high cost for its control, largely born by international donors. We assessed feasible targets, likely impact and costs for the 2015-2019 national strategic HIV/AIDS plan (NSP).

Methods: The HIV epidemic and response was modelled in the Spectrum/Goals/Resource Needs dynamical simulation model, separately for North/Center/South regions, fitted to antenatal clinic surveillance data, household and key risk group surveys, program statistics, and financial records. Intervention targets were defined in collaboration with the National AIDS Council, Ministry of Health, technical partners and implementing NGOs, considering existing commitments.

Results: Implementing the NSP to meet existing coverage targets would reduce annual new infections among all ages from 105,000 in 2014 to 78,000 in 2019, and reduce annual HIV/AIDS-related deaths from 80,000 to 56,000. Additional scale-up of prevention interventions targeting high-risk groups, with improved patient retention on ART, could further reduce burden to 65,000 new infections and 51,000 HIV-related deaths in 2019. Program cost would increase from US$ 273 million in 2014, to US$ 433 million in 2019 for 'Current targets', or US$ 495 million in 2019 for 'Accelerated scale-up'. The 'Accelerated scale-up' would lower cost per infection averted, due to an enhanced focus on behavioural prevention for high-risk groups. Cost and mortality impact are driven by ART, which accounts for 53% of resource needs in 2019. Infections averted are driven by scale-up of interventions targeting sex work (North, rising epidemic) and voluntary male circumcision (Center & South, generalized epidemics).

Conclusion: The NSP could aim to reduce annual new HIV infections and deaths by 2019 by 30% and 40%, respectively, from 2014 levels. Achieving incidence and mortality reductions corresponding to UNAIDS' 'Fast track' targets will require increased ART coverage and additional behavioural prevention targeting key risk groups.

Show MeSH
Related in: MedlinePlus