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Abstract
Funding HIV prevention in developing countries: equity vs. efficiency
A. Lasry1, G.S. Zaric2, M.W. Carter3
1University of Toronto, Department of Mechanical & Industrial Engineering, Montreal, Canada, 2University of Western Ontario, Ivey School of Business, London, Canada, 3University of Toronto, Department of Mechanical & Industrial Engineering, Toronto, Canada
Background: Funds spent on HIV prevention commonly traverse several levels of distribution. Funds may be allocated to regions, and regional authorities may then allocate their share to sub-regions or targeted risk groups. Decision makers at each level often use equity approaches that may result in suboptimal allocation of resources. We examine the impact of optimal versus equity-based allocation of HIV prevention funds when there are two levels of decision making.
Methods: We consider two lower level regions, each divided into two sub-populations, high risk and low risk. Sub-populations are modeled as a four-compartment epidemics model where the population is divided by disease state and maturity. We consider two allocation approaches: optimization, which aims to minimize the number of new infections; and equity, which allocates funds proportionally to the number of HIV cases. The model is populated using data from Kenya and Botswana.
Results: In the baseline scenario, the gap between the best solution approach (optimization at both levels) and the worst solution approach (equity at both levels), represents an 8% decrease in the number of new infections. But, 85% of the gap lies between the equity at the lower level and optimization at the upper level approach, and the optimization at the lower level and equity at the upper level approach. In 200 scenarios evaluated, when optimization is applied to one level, there are fewer new infections if it is applied at the lower level than the upper level.
Conclusions: HIV resource allocation approaches strongly influence epidemic outcomes and serious consideration should be given to optimizing the lower levels of decision-making. The importance of the HIV allocation approaches increases when resources are more constrained. Decision-makers should not focus solely on higher level allocations; this can yield ineffective use of scarce resources.
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