PMID- 36962380
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230327
IS  - 2767-3375 (Electronic)
IS  - 2767-3375 (Linking)
VI  - 2
IP  - 8
DP  - 2022
TI  - Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 
      and 2018: A data envelopment analysis.
PG  - e0000463
LID - 10.1371/journal.pgph.0000463 [doi]
LID - e0000463
AB  - HIV/AIDS remains a leading global cause of disease burden, especially in low- and 
      middle-income countries (LMICs). In 2020, more than 80% of all people living with 
      HIV (PLHIV) lived in LMICs. While progress has been made in extending coverage of 
      HIV/AIDS services, only 66% of all PLHIV were virally suppressed at the end of 
      2020. In addition to more resources, the efficiency of spending is key to 
      accelerating progress towards global 2030 targets for HIV/AIDs, including viral 
      load suppression. This study aims to estimate the efficiency of HIV/AIDS spending 
      across 78 countries. We employed a data envelopment analysis (DEA) and a 
      truncated regression to estimate the technical efficiency of 78 countries, mostly 
      low- and middle-income, in delivering HIV/AIDS services from 2010 to 2018. 
      Publicly available data informed the model. We considered national HIV/AIDS 
      spending as the DEA input, and prevention of mother to child transmission (PMTCT) 
      and antiretroviral treatment (ART) as outputs. The model was adjusted by 
      independent variables to account for country characteristics and investigate 
      associations with technical efficiency. On average, there has been substantial 
      improvement in technical efficiency over time. Spending was converted into 
      outputs almost twice as efficiently in 2018 (81.8%; 95% CI = 77.64, 85.99) 
      compared with 2010 (47.5%; 95% CI = 43.4, 51.6). Average technical efficiency was 
      66.9% between 2010 and 2018, in other words 33.1% more outputs could have been 
      produced relative to existing levels for the same amount of spending. There is 
      also some variation between WHO/UNAIDS regions. European and Eastern and Southern 
      Africa regions converted spending into outputs most efficiently between 2010 and 
      2018. Rule of Law, Gross National Income, Human Development Index, HIV prevalence 
      and out-of-pocket expenditures were all significantly associated with efficiency 
      scores. The technical efficiency of HIV investments has improved over time. 
      However, there remains scope to substantially increase HIV/AIDS spending 
      efficiency and improve progress towards 2030 global targets for HIV/AIDS. Given 
      that many of the most efficient countries did not meet 2020 global HIV targets, 
      our study supports the WHO call for additional investment in HIV/AIDS prevention 
      and control to meet the 2030 HIV/AIDS and eradication of the AIDS epidemic.
CI  - Copyright: (c) 2022 Allel et al. This is an open access article distributed under 
      the terms of the Creative Commons Attribution License, which permits unrestricted 
      use, distribution, and reproduction in any medium, provided the original author 
      and source are credited.
FAU - Allel, Kasim
AU  - Allel K
AUID- ORCID: 0000-0002-2144-7181
AD  - Institute for Global Health, University College London, London, United Kingdom.
FAU - Abou Jaoude, Gerard Joseph
AU  - Abou Jaoude GJ
AUID- ORCID: 0000-0001-6022-3036
AD  - Institute for Global Health, University College London, London, United Kingdom.
FAU - Birungi, Charles
AU  - Birungi C
AUID- ORCID: 0000-0001-7625-1656
AD  - Institute for Global Health, University College London, London, United Kingdom.
AD  - United Nations Joint Programme on HIV and AIDS (UNAIDS), Harare, Zimbabwe.
FAU - Palmer, Tom
AU  - Palmer T
AUID- ORCID: 0000-0002-9526-0045
AD  - Institute for Global Health, University College London, London, United Kingdom.
FAU - Skordis, Jolene
AU  - Skordis J
AUID- ORCID: 0000-0002-8633-0208
AD  - Institute for Global Health, University College London, London, United Kingdom.
FAU - Haghparast-Bidgoli, Hassan
AU  - Haghparast-Bidgoli H
AUID- ORCID: 0000-0001-6365-2944
AD  - Institute for Global Health, University College London, London, United Kingdom.
LA  - eng
PT  - Journal Article
DEP - 20220801
PL  - United States
TA  - PLOS Glob Public Health
JT  - PLOS global public health
JID - 9918283779606676
PMC - PMC10022340
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/03/25 06:00
MHDA- 2023/03/25 06:01
PMCR- 2022/08/01
CRDT- 2023/03/24 17:59
PHST- 2021/09/29 00:00 [received]
PHST- 2022/06/27 00:00 [accepted]
PHST- 2023/03/24 17:59 [entrez]
PHST- 2023/03/25 06:00 [pubmed]
PHST- 2023/03/25 06:01 [medline]
PHST- 2022/08/01 00:00 [pmc-release]
AID - PGPH-D-21-00738 [pii]
AID - 10.1371/journal.pgph.0000463 [doi]
PST - epublish
SO  - PLOS Glob Public Health. 2022 Aug 1;2(8):e0000463. doi: 
      10.1371/journal.pgph.0000463. eCollection 2022.