Introduction: Although investment in HIV/AIDS prevention has increased worldwide, it remains uncertain how the additional resources can be most efficiently allocated to maximize the number of infections averted, especially at the country, regional and local levels.
Methods: Data from developing countries in Africa, Asia and Latin America were reviewed on the allocation of HIV/AIDS prevention funds in relation to the prevalence of infection, as well as budgetary allocations for specific population groups at high risk of infection, such as sex workers, intravenous drug users and men who have sex with men. The variation in unit costs of voluntary counselling and testing in five countries was also examined.
Results: Evidence was found of three distinct sources of inefficiency in the allocation of HIV/AIDS prevention resources: inefficiency in the mix of interventions selected; inefficient targeting of key populations; and technical inefficiency in the production of HIV prevention services.
Conclusion: A general conceptual framework for evaluating the efficiency of HIV/AIDS prevention programmes at the country, regional and local levels is proposed. This framework stresses three equally important components of programme efficiency: cost-effectiveness (the choice of the mix of interventions); targeting (the choice of the mix of target populations); and technical efficiency (the delivery of prevention services at least cost).
From the aNational Institute of Public Health, Cuernavaca, Mexico
bMassachusetts Institute of Technology, Cambridge, Massachusetts, USA
cCenter for Economic Research and Teaching (CIDE), Mexico City, Mexico
dUniversity of California, Berkeley, California, USA.
Correspondence to Stefano M. Bertozzi, Instituto Nacional de Salud Pública, Avenida Universidad 655, Cuernavaca, Morelos 62508, México. Tel: +52 777 329 3069; fax: +52 777 311 1156; e-mail: email@example.com