Improving the Efficiency of the HIV/AIDS Policy Response: A Guide to Resource Allocation Modeling

In: Major Infectious Diseases. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 3. Chapter 9.


Resources devoted to combating the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) have increased dramatically since 2005 (Dieleman and others 2014). However, the rate of increase has slowed in recent years, even though the commitment required to serve all of those in need and to reverse the epidemic has not been reached (Schwärtlander and others 2011; UNAIDS 2013, 2014; WHO 2013). In addition, new recommendations to start treatment earlier in the disease course mean that more resources will be needed than previously estimated. Many of the countries with the highest prevalence of HIV/AIDS have low incomes and carry a heavy burden of other diseases, and it is particularly important to deploy resources judiciously. Finally, efficiency is an even greater imperative in the current era of transition away from funding dominated by international donor aid toward a funding model in which the national governments in affected countries bear a larger portion of the costs; this is especially so since, by some metrics, national governments are failing to increase their own contributions rapidly enough (Resch, Ryckman, and Hecht 2015). Ensuring that available resources are allocated to the most-cost-effective activities is essential to pursuing the aspirational “Getting to Zero” goals of the Joint United Nations Programme on HIV/AIDS (UNAIDS): zero new infections, zero AIDS-related deaths, and zero discrimination. Similar challenges also face global efforts to control tuberculosis and malaria—resources fall short of ambitious prevention and treatment targets.

Various effectiveness, cost-effectiveness, and resource allocation models have been developed to evaluate the costs and outcomes of the choices facing HIV/AIDS policy makers at national and international levels. This chapter presents an overview—including features, uses, and limitations—of the small subset of models that explores the allocation of HIV/AIDS resources across many intervention options and purposes. It does not assess the more numerous models that analyze the cost-effectiveness of one or a few interventions for one purpose. Accordingly, it assesses the set of software tools that portray a wide range of interventions and combinations of interventions in different settings with the goal of providing broad guidance for improved resource allocation.

Publication types

  • Review