On the fast track to end AIDS: improving efficiency to maximize impact

Getting on the Fast-Track [to end AIDS] will require additional investment—and wiser use of that investment.

For this year’s World AIDS Day, the Joint United Nations Programme on HIV/AIDS (UNAIDS) is calling for heightened efforts to end AIDS by 2030. To achieve this ambitious goal, UNAIDS has implored its global and country partners to look beyond traditional models of program implementation and service delivery.

The report, On the Fast-Track to end AIDS by 2030: Focus on location and population, emphasizes an area of particular promise, a mechanism to optimize HIV service delivery: improving program efficiency. Or as UNAIDS aptly describes it, “by providing the right services to the right people in the right place – and by providing these services in the right way.”

Economists define this type of efficiency as the effectiveness with which a set of resources (inputs) are used to produce something (outputs). Maximizing efficiency, economists argue, is a key avenue for scaling up services without a proportional rise in costs.

In a health system, an efficient health facility is one in which resources (e.g., medical staff, hospital beds, equipment) are used at full capacity, supporting a high volume of patient visits and services without straining facility resources. On the other hand, inefficient facilities are ones where resources have yet to be fully maximized, with staff seeing few patients or usable beds remaining empty.

So why is improving program efficiency critical to fast-tracking the end of AIDS? While HIV-focused development assistance for health (DAH) rapidly rose between 2000 and 2010, funding has stagnated ever since. Massive progress has occurred in providing life-saving antiretroviral therapy (ART) to people living with AIDS; nonetheless, the unmet need for ART still exceeds current enrollment in treatment. With researchers predicting a widening HIV funding gap, it is increasingly important to identify ways to provide more ART services to more patients – and to do so within tightening budgets.

In its new report, UNAIDS points to a “wiser use” of HIV investments, emphasizing that efforts to integrate HIV services within primary care and target high-risk populations could help reduce inefficiencies and costs. The report also highlights a number of country strategies to increase ART program efficiencies, as well as areas for further improvement. For example, drawing from the Access, Bottlenecks, Costs, and Equity (ABCE) project, UNAIDS shows that health facilities in Kenya, Uganda, and Zambia could serve many more ART patients using observed resources.

Throughout the world, rates of new HIV cases and mortality have substantially fallen, a trend driven by an unprecedented response to halt the AIDS epidemic. But as indicated by UNAIDS’ new report, ending AIDS will likely require more than expanded funding or additional medical staff. Instead, a focus on improving the efficiency – and quality – of ART services is a pathway toward more sustainable, healthier futures for people living with HIV.