title: Spending of HIV resources in Asia and Eastern Europe: systematic review reveals the need to shift funding allocations towards priority populations.
abstract: BACKGROUND
  It is increasingly important to prioritize the most cost-effective HIV interventions. We sought to summarize the evidence on which types of interventions provide the best value for money in regions with concentrated HIV epidemics.
  
  
  METHODS
  We conducted a systematic review of peer-reviewed and grey literature reporting measurements of cost-effectiveness or cost-benefit for HIV/AIDS interventions in Asia and Eastern Europe. We also collated HIV/AIDS spending assessment data from case-study countries in the region.
  
  
  RESULTS
  We identified 91 studies for inclusion, 47 of which were from peer-reviewed journals. Generally, in concentrated settings, prevention of mother-to-child transmission programmes and prevention programmes targeting people who inject drugs and sex workers had lower incremental cost-effectiveness ratios than programmes aimed at the general population. The few studies evaluating programmes targeting men who have sex with men indicate moderate cost-effectiveness. Collation of prevention programme spending data from 12 countries in the region (none of which had generalized epidemics) indicated that resources for the general population/non-targeted was greater than 30% for eight countries and greater than 50% for five countries.
  
  
  CONCLUSIONS
  There is a misalignment between national spending on HIV/AIDS responses and the most affected populations across the region. In concentrated epidemics, scarce funding should be directed more towards most-at-risk populations. Reaching consensus on general principles of cost-effectiveness of programmes by epidemic settings is difficult due to inconsistent evaluation approaches. Adopting a standard costing, impact evaluation, benefits calculation, analysis and reporting framework would enable cross comparisons and improve HIV resource prioritization and allocation.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Craig
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Hla-Hla
authors.initials: HH
authors.lastname: Thein
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Gray
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Klara
authors.initials: K
authors.lastname: Henderson
authors.affiliation: World Bank Group, Washington, DC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Wilson
authors.affiliation: World Bank Group, Washington, DC, USA.
authors.forename: Marelize
authors.initials: M
authors.lastname: Gorgens
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; dwilson@unsw.edu.au.
authors.forename: David P
authors.initials: DP
authors.lastname: Wilson
mesh_terms: D001208:Asia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005061:Europe, Eastern / Q000453:epidemiology; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control*; D006292:Health Priorities / Q000191:economics; D018451:Homosexuality, Male; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control; D008297:Male; D040841:Resource Allocation / Q000191:economics
keywords: Asia; Eastern Europe; HIV; concentrated epidemics; cost-benefit analyses; cost-effectiveness; programme evaluation; systematic review