Dutta Arin et al. The Global HIV Epidemics among People Who Inject Drugs

World Bank Publications, 2012. — 135 p.Authors: Arin Dutta, Andrea Wirtz, Anderson Stanciole, Robert Oelrichs, Iris Semini, Stefan Baral, Carel Pretorius, Caroline Haworth, Shannon Hader, Chris Beyrer, and Farley Cleghorn
This report conducts a review of recent systematic reviews of the four key interventions initial group of countries that represented a diverse selection across PWID-HIV epidemic contexts. They represent a sub-Saharan epidemic context (Kenya), Eastern Europe and its established HIV epidemics among PWID (Ukraine), South Asia and its developing epidemics among PWID (Pakistan), and Southeast Asia with its mature HIV epidemics among PWID (Thailand).
For each case study, the modeled time period for expansion of coverage of the four key interventions was 2012–2015, and the base year was 2011. The following research questions were used for the modeling component of each case study.
a. What is the impact on HIV incidence of implementing the key interven-
tions at a level of coverage eliminating a substantial portion of the unmet need?
b. What is the cost of expanding the key interventions to eliminate the unmet need? Based on direct effects, what is the cost-effectiveness of the expansion?
c. What is the uncertainty around costing and cost-effectiveness results for implementation of the four key interventions and how can these uncertain- ties best be addressed?
We use the Goals mathematical model to conduct the analysis. This model
has been utilized in multiple studies over the last decade, including for a similar report on MSM. For each country case study, we model the following scenarios:
• Status Quo: No change in the coverage of ART, NSP, MAT, or HCT for
PWID over the years 2011–15.
• Baseline: In this scenario the increase from levels of coverage of NSP, MAT, and HCT for PWID from the base year of 2011 across the period 2012–2015 is as per existing national plans. This coverage over 2012–2015 may be the same as the level in 2011 if we foresee no meaningful expansion or if plans do not call for increase. In this scenario, ART coverage increases every year over 2012–2015 based on the country’s current scale-up plan for adult treatment. The Baseline scenario assumes that PWID have proportionate access to ART slots as the intervention scales up.