title: Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies.
abstract: BACKGROUND
  Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels.
  
  
  METHODS
  We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure-two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment.
  
  
  RESULTS
  Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%-39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%-58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%-27%] reduction in management costs, and allocating resources optimally.
  
  
  CONCLUSIONS
  With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Andrew J
authors.identifier: http://orcid.org/0000-0002-2285-8425
authors.initials: AJ
authors.lastname: Shattock
authors.affiliation: The World Bank Group, Washington DC, United States of America.
authors.forename: Clemens
authors.initials: C
authors.lastname: Benedikt
authors.affiliation: Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland.
authors.forename: Aliya
authors.initials: A
authors.lastname: Bokazhanova
authors.affiliation: United Nations Development Programme, Istanbul Regional Hub, Istanbul, Turkey.
authors.forename: Predrag
authors.initials: P
authors.lastname: Đurić
authors.affiliation: Republican Center for Prevention and Control of AIDS, Almaty, Kazakhstan.
authors.forename: Irina
authors.initials: I
authors.lastname: Petrenko
authors.affiliation: Republican Center for Prevention and Control of AIDS, Almaty, Kazakhstan.
authors.forename: Lolita
authors.initials: L
authors.lastname: Ganina
authors.affiliation: The Burnet Institute, Melbourne, Australia.
authors.forename: Sherrie L
authors.initials: SL
authors.lastname: Kelly
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.|Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Stuart
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.|School of Physics, University of Sydney, Sydney, Australia.
authors.forename: Cliff C
authors.initials: CC
authors.lastname: Kerr
authors.affiliation: The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Vinichenko
authors.affiliation: The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors.forename: Shufang
authors.initials: S
authors.lastname: Zhang
authors.affiliation: United Nations Development Programme, Istanbul Regional Hub, Istanbul, Turkey.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hamelmann
authors.affiliation: Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland.
authors.forename: Manoela
authors.initials: M
authors.lastname: Manova
authors.affiliation: The World Bank Group, Washington DC, United States of America.
authors.forename: Emiko
authors.initials: E
authors.lastname: Masaki
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.|The Burnet Institute, Melbourne, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Wilson
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005378:Financial Support; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D017048:Health Care Costs / Q000331:legislation & jurisprudence*; D006284:Health Plan Implementation; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007623:Kazakhstan; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000331:legislation & jurisprudence*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents