Study On Hiv/aids Epidemic Dynamics And Resource Allocation And Utilization In Dehong Prefecture, Yunnan Province

Background:Dehong Prefecture is one of the priority areas for HIV/AIDS prevention and care in China, where about RMB 11 million Yuan has been allocated since 2004. According to case report data, recently, proportion of cases through sexual transmission has increased and overtaken that of drug use. Fully understanding HIV/AIDS epidemic trend and the effectiveness of current resource allocation and utilization will be helpful for proper resource allocation in the future.Objective:Analyze the HIV/AIDS epidemic dynamics; evaluate the sources, allocation and effectiveness of resources for HIV/AIDS prevention and care in Dehong, and propose optimal plan for the future resource allocation.Method:Analyze the data from case reports, testing and counseling, sentinel surveillance and special surveys on sexual transmission each year. Make judgments on the dynamics of transmissions based on Asia Epidemic Model (AEM) and Workbook models. Collect data on source, allocation and actual utilization of funds in Dehong by using questionnaire survey. Cost effectiveness were estimated for intervention to female sex workers and methadone maintenance therapy respectively by using SEX 2.0 software and incidence method. Resource needs and effectiveness were evaluated from 2008 to 2012 by utilizing NEAR system.Results:According to case reports from 2005 to 2007, proportions of cases by sexual transmission were 39.1,46.9 and 65.5 percent. The result of AEM model indicated that from 2005 to 2007, proportions of incidence cases by sexual transmission has already surpassed that by drug use. But both were around 50 percent. According to Workbook method, an estimated 50.3% are through drug use, while 48.4% by sexual transmission among the people living with HIV (PLHIV). Total resources allocated for HIV/AIDS prevention and care from 2000-2007 was RMB 80.597 million Yuan, of which the biggest (40.7%) is from the central government earmarked transfer budget. The unit cost for female sex workers intervention is 294.8 RMB and the cost effectiveness ratio is 13,283 RMB. The cost effectiveness ratio for methadone maintenance therapy is 31870 to 60,574 RMB. From 2008 to 2012, total resource needs are estimated as RMB 158 million Yuan. If inputs for interventions for drug users are increased,1,112 people will be prevented from infecting HIV. The cost-effectiveness ratio is thus 74,146 RMB. And the investment plan for both IDUs and CSWS the number of cases of HIV to be avoided is 1636 people. The cost-effectiveness ratio is thus 96,353 RMB.Conclusion:HIV transmissions through sexual and drug use are both important for the HIV/AIDS epidemic in Dehong Prefecture. The current resource allocation for HIV/AIDS prevention and care is basically rational, but there is resource gap. Interventions among female sex workers and methadone maintenance therapy are both cost-effective.