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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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HIV incidence rate by region of Mozambique (a-c) and national total annual new HIV infections (d); HIV-related mortality rate by region of Mozambique (e-g) and national total annual HIV-related deaths, in three NSP scenarios, each for adults 15–49 years.
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pone.0142908.g002: HIV incidence rate by region of Mozambique (a-c) and national total annual new HIV infections (d); HIV-related mortality rate by region of Mozambique (e-g) and national total annual HIV-related deaths, in three NSP scenarios, each for adults 15–49 years.

Mentions: Under ‘Constant coverage’, the Goals model projects a fairly stable HIV incidence over 2015–2019, close to rates in 2014, in all 3 regions (Fig 2A–2C). In the advanced epidemics in Southern and Center regions, this stable incidence follows a progressive decline from peaks around and before 2003, respectively. In the North, incidence is stable at a level similar to that since 2002, although with a slight temporary decline around 2014–2015 which follows rapid ART scale-up over 2013–2014.


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)

HIV incidence rate by region of Mozambique (a-c) and national total annual new HIV infections (d); HIV-related mortality rate by region of Mozambique (e-g) and national total annual HIV-related deaths, in three NSP scenarios, each for adults 15–49 years.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0142908.g002: HIV incidence rate by region of Mozambique (a-c) and national total annual new HIV infections (d); HIV-related mortality rate by region of Mozambique (e-g) and national total annual HIV-related deaths, in three NSP scenarios, each for adults 15–49 years.
Mentions: Under ‘Constant coverage’, the Goals model projects a fairly stable HIV incidence over 2015–2019, close to rates in 2014, in all 3 regions (Fig 2A–2C). In the advanced epidemics in Southern and Center regions, this stable incidence follows a progressive decline from peaks around and before 2003, respectively. In the North, incidence is stable at a level similar to that since 2002, although with a slight temporary decline around 2014–2015 which follows rapid ART scale-up over 2013–2014.

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