Millions in need of HIV services will continue to be left out

Millions of people in need would benefit from HIV services in developing countries that are moving towards universal health coverage if these services were run more efficiently and integrated better into their health systems.

According to a study published in the Bulletin of the World Health Organization today, scaling up HIV services can achieve substantially lower unit-costs per patient, while integrating these services with other health-care services, such as for tuberculosis, can achieve better value for money than stand-alone services.

The study, by authors from the London School of Hygiene and Tropical Medicine and UNAIDS, is important because it points the way forward - not only for HIV services where US$ 19 billion was invested globally in 2012 - but for all services for chronic conditions, such as heart disease, cancer, diabetes and hypertension.

"HIV is one field where there seems to be a scientific consensus not only about what works but also about the most efficient ways to delivery health care," said Jeremy Lauer, a health economist in the department of Health Systems Governance and Financing at the World Health Organization (WHO).

"Economic evaluation of other health programmes also shows strong evidence from an economic, programmatic and ethical perspective to support comprehensive delivery models - ones that cover the complete spectrum of prevention, detection, treatment and care," he said.

"When you have comprehensive care for managing chronic conditions like HIV/AIDS - better prevention means less treatment, and early detection and effective treatment lead to better health outcomes for the patients," Lauer said.

In 2011, WHO's Member States set themselves the goal of developing their health financing systems as a stepping stone to universal health coverage. WHO is working with countries to review, develop and implement health financing strategies that could help them to move closer towards that goal.

In the field of HIV, progress has been made in making prevention and treatment services more widely available in low and middle-income countries. In the early 2000s, fewer than 50 000 people in sub-Saharan Africa were on antiretroviral treatment, but by the end of 2012 an estimated 9.7 million people in low and middle-income countries were receiving it.

Still, that covers only 34% of the 28.6 million people who are eligible for antiretroviral treatment, according to 2013 WHO guidelines.

The World Health Organization is currently revising its cost-effectiveness estimates for 20 diseases, risk factors and causes of injury, including in the field of HIV infection. The resulting review will serve as an evidence base for WHO guidance to countries on the path to universal health coverage.

The new study, by a team of researchers based in London and Geneva, which precedes the WHO review, analyzes 82 economic evaluation studies of HIV services in 35 low and middle-income countries.