Optimizing HIV Spending Among Key Populations in Five Latin American and Caribbean Countries: A Mathematical...

Area of Science:

• Epidemiology
• Public Health
• Health Economics

Background:

• Latin America and the Caribbean face rising HIV rates, with slowed progress in reduction.
• Allocative efficiency studies are crucial for optimizing HIV spending in the region.

Purpose of the Study:

• To estimate optimal HIV spending allocation for maximum impact in five Latin American and Caribbean countries.
• To model future HIV incidence, mortality, and resource needs under various scenarios.

Main Methods:

• Developed national Optima HIV models for Colombia, Costa Rica, Dominican Republic, El Salvador, and Honduras.
• Incorporated country-specific data on key populations, costs, coverage, and effectiveness of prevention, testing, and ART interventions.
• Projected outcomes for 2025-2030 under status quo, fixed spending, and optimized spending scenarios.

Main Results:

• Optimizing resources could avert 18%-33% of new HIV acquisitions and 5%-31% of deaths by prioritizing ART.
• Further reductions (23%-69% of acquisitions, 8%-61% of deaths) are possible with reduced ART costs and reinvestment in key population interventions.
• Transgender women and men who have sex with men exhibit the highest HIV incidence rates.

Conclusions:

• HIV spending can be reallocated to reduce new infections and deaths in Latin America and the Caribbean without additional funding.
• Reduced treatment costs allow for increased investment in key population-focused services, amplifying epidemic control.
• Aligning resources with epidemic drivers and expanding targeted prevention for key populations is essential.