Efficient HIV Responses in Eastern Europe and Central Asia
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Tackling the World’s Fastest- Growing HIV Epidemic HUMAN DEVELOPMENT PERSPECTIVES Tackling the World’s Fastest-Growing HIV Epidemic More Efficient HIV Responses in Eastern Europe and Central Asia Feng Zhao, Clemens Benedikt, and David Wilson, Editors © 2020 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington, DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved 1 2 3 4 23 22 21 20 This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. 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Human Development Perspectives The books in this series address main and emerging development issues of a global/regional nature through original research and findings in the areas of education, gender, health, nutrition, population, and social protection and jobs. The series is aimed at policy makers and area experts and is over- seen by the Human Development Practice Group Chief Economist. Previous titles in this series Meera Shekar and Barry Popkin, Obesity: Health and Economic Consequences of an Impending Global Challenge (2020). Truman Packard, Ugo Gentilini, Margaret Grosh, Philip O’Keefe, Robert Palacios, David Robalino, and Indhira Santos, Protecting All: Risk Sharing for a Diverse and Diversifying World of Work (2019). Damien de Walque, Risking Your Health: Causes, Consequences, and Interventions to Prevent Risky Behaviors (2014). Rita Almeida, Jere Behrman, and David Robalino, The Right Skills for the Job? Rethinking Training Policies for Workers (2012). Barbara Bruns, Deon Filmer, and Harry Anthony Patrinos, Making Schools Work: New Evidence on Accountability Reforms (2011). Harold Alderman, No Small Matter: The Impact of Poverty, Shocks, and Human Capital Investments in Early Childhood Development (2011). All books in the Human Development Perspectives series are available at https://openknowledge.worldbank.org/handle/10986/2161. Contents Acknowledgments xxi Abbreviations xxv Introduction 1 Feng Zhao, Clemens Benedikt, and Katherine Ward Part I: The Growing Challenge The Fastest-Growing HIV Epidemic in the World 2 A Concentrated but Diversifying Epidemic 4 Ongoing Barriers to Treatment 8 The Rising Importance of Domestic Financing 10 Part II: Using Allocative Efficiency Analysis to Chart the Way Forward Scaling Up Treatment and Prevention 13 Variations in HIV Spending Levels 14 Varying Costs per Person Reached 17 Recommendations 19 Advanced Concentrated HIV Epidemics 23 Notes 23 References 24 vii viii | Contents Chapter 1: Cost-Effectiveness 2.0 27 Improving Allocative Efficiency with Decision Science Analytics David P. Wilson and Marelize Görgens Introduction 27 Avoiding Inefficiency 30 Shortcomings of Traditional Cost-Effectiveness Analyses 33 The Optima Model for Choosing Interventions 35 Questions Answered through an Optima Analysis 42 Evolution of Optima Tools 42 Conclusions and Future Directions 47 Note 50 References 50 Chapter 2: Armenia 57 Mobilizing an HIV Response When a Key Population Is Mobile Samvel Grigoryan, Sherrie L. Kelly, Arshak Papoyan, Ruben Hovhannisyan, Trdat Grigoryan, David P. Wilson, Diego Cuadros, and Wendy Heard Briefly 57 Introduction 57 The Allocative Efficiency Analysis 64 Optimally Investing HIV Resources 66 Conclusions and Recommendations 71 Actions Taken and Next Steps 73 Notes 74 References 74 Chapter 3: Belarus 75 Changing HIV Budgets Based on Allocative Efficiency Analysis Alena Fisenka, Richard T. Gray, Pavel Yurouski, Vera Ilyenkova, David P. Wilson, Marelize Görgens, and Clemens Benedikt Briefly 75 Introduction 75 Contents | ix Initial Study Results and Their Interpretation 78 Reallocating Funds Based on Findings 86 Conclusions 92 Notes 92 Reference 92 Chapter 4: Bulgaria 93 Transitioning to Domestic Financing of HIV Programs amid High Costs Tonka Varleva, Hristo Taskov, Tsveta Raycheva, Emilia Naseva, Petar Tsintsarski, Nina Yancheva, Vyara Georgieva, Laura Grobicki, Jolene Skordis-Worrall, Feng Zhao, and Nejma Cheikh Briefly 93 Introduction 93 Funding Analysis Study 98 Allocative Efficiency Analysis Recommendations 103 Conclusions 105 Notes 106 References 106 Chapter 5: Georgia 109 An HIV Epidemic among Men Who Have Sex with Men Ketevan Stvilia, Irma Khonelidze, Hassan Haghparast- Bidgoli, Cliff C. Kerr, Feng Zhao, and Marelize Görgens Briefly 109 Introduction 110 The 2015 Allocative Efficiency Analysis 112 Allocative Efficiency Analysis Recommendations 122 Actions Taken and Next Steps 124 Notes 125 References 126 Chapter 6: Kazakhstan 129 Achieving Ambitious HIV Targets through Efficient Spending Andrew J. Shattock, Aliya Bokazhanova, Manoela Manova, Baurzhan S. Baiserkin, Irina Petrenko, David P. Wilson, Clemens Benedikt, and Nejma Cheikh x | Contents Briefly 129 Introduction 129 Efficiency Analysis Performed 133 Optimizing Allocations for Specific Targets 134 Policy Implications 141 Notes on the Modeling 144 Recommendations 145 Making Use of the Results 147 Notes 149 References 149 Chapter 7: Kyrgyz Republic 155 Addressing the HIV Treatment Gap Meerim Sarybaeva, Andrew J. Shattock, Talgat Mambetov, Larisa Bashmakova, Liutsiia Ianbukhtina, Manoela Manova, Richard T. Gray, Clemens Benedikt, and Katherine Ward Briefly 155 Introduction 155 Overview of the Epidemic 156 Funding for HIV Programming 158 Reducing New Infections and Deaths 160 Optima Analysis Findings 164 Actions Taken and Next Steps 169 Conclusions 178 Notes 179 References 180 Chapter 8: Moldova 181 Designing Efficient HIV Programs for Subnational HIV Epidemics Svetlana Plamadeala, Richard T. Gray, Iulian Oltu, Lucia Pirtina, Svetlana Popovici, Lilia Gantea, David P. Wilson, Alona Goroshko, and Clemens Benedikt Briefly 181 Introduction 182 HIV Allocative Efficiency Analysis 184 Understanding the HIV Epidemic 187 Allocative Efficiency Analysis Recommendations 200 Contents | xi Making Use of the Findings 202 Notes 204 References 204 Chapter 9: North Macedonia 207 Tackling a Small but Rapidly Growing Epidemic Vladimir Mikik, Laura Grobicki, Lidija Kirandjiska, Natasha Nikolovska Stankovikj, Jasmina Panovska-Griffiths, Feng Zhao, and Katherine Ward Briefly 207 Introduction 207 Projections from the Allocative Efficiency Analysis 210 Sustaining Effectiveness through Efficiency Gains 222 Allocative Efficiency Analysis Recommendations 224 Actions Taken and Next Steps 227 Notes 228 References 228 Chapter 10: Tajikistan 231 Toward a Rights-Based Response for Key