Kim, SW; (2017) Improving the efficiency of HIV care: exploring the role of global donor strategies on access to prevention, testing and treatment. Doctoral thesis , UCL (University College London).

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Abstract

As the growth of donor funding for HIV/AIDS begins to slow and the increasing burden of non-communicable diseases forces funders and policy makers to reassess health systems priorities – it is important to understand the most efficient way to allocate scarce health resources. The aim of this PhD thesis is to investigate whether the activities of global donors improved the efficiency of HIV programmes from a global perspective. This thesis will use a case study approach to focus on three key activities of global donors in the HIV treatment process: harm reduction, HIV testing and drug procurement. This thesis will provide empirical evidence on the cost effectiveness of harm reductive in the Ukraine, the equity of HIV testing in Malawi, and the efficiency of centralising procurement of HIV drugs at the international level. Each theme is explored using a single country case study. Research methods exploit widely available datasets not yet used to answer these questions. Each chapter describes the methods used for the analyses i.e., Markov Monte-Carlo simulation, a decomposed concentration index and difference-in-difference analysis. The findings of these analyses are as follows; Chapter 2 concludes that the harm reduction programme in the Ukraine is cost effective in terms of QALYs gained and infections averted. Chapter 3 demonstrates that existing inequity in HIV testing has been reduced and highlights how socio economic factors such as income, education and gender influence inequity in HIV testing in Malawi. Chapter 4 shows that voluntary pooled procurement can effectively reduce the procurement price of an HIV drug. Given these findings, this thesis suggests that strategies adopted by global donors have improved the efficiency of HIV care in these contexts.

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