Impact of National HIV Policy and Funding on Social and Demographic Indicators in Russia
Authors: N.A. Avksentiev, A.S. Makarov, Yu.V. Makarova, E.M. Pazukhina, N.N. Sisigina, O.A. Feoktistova, E.E. Zaytseva, S.D. Kuznetsov, A. Paice, K.I Saytkulov
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A number of governmental anti-HIV strategic programs are being implemented today in Russia; however, as of 2020, only 74.5% of the infected were aware of their status and only 67.4% of them were receiving the therapy. Under such conditions, it seems reasonable to assess future social and economic consequences depending on various scenarios of centralized financing of anti-HIV activities in the future. With the use of mathematic modelling, an economic analysis was performed for the “no change” scenario of maintaining costs for HIV control at the level of 2020, and a prognosis was made for 4 possible scenarios of national policy changes in relation to federal expenditures: a 25% and 50% increase in expenditures from the level of 2020, a “maximum extensive scenario” (which assumes reaching the upper limit of expenditures with approximately 60% growth while maintaining the current structure of costs), and an “intensive” scenario with an increase in nominal expenditures and shifting costs to purchasing newer third-generation antiretroviral therapy regimens. According to the modelling results, the current financial strategy (the “no change” scenario) in nominal terms will result in HIV mortality growth up to 25 thousand cases annually, the economic burden over the period of 2020–2030 will exceed RUB 4 bln and will not let achieving the national target of “90-90-90” by 2024. Under this scenario, Russia would remain the leader in HIV prevalence among the countries of Eastern Europe and Central Asia. The “no change” scenario would result in indirect economic losses of RUB 3,481.06 bln per year, with epidemiological parameters still high. The most efficient scenario turned out to be the “maximum extensive scenario” that suggests an increase in federal budget expenditures on combating HIV infection by approximately RUB 20 bln annually. This course of events would allow reducing HIV mortality to 5.4 cases per 100 thsd population by 2030, which is comparable to the current HIV mortality in Spain, Italy and Switzerland, and reducing HIV mortality by 111,9 thsd cases to a level comparable to that of the USA, Chile and New Zealand in 2019. The economic benefit from the implementation of this scenario in 2020–2030 would amount to RUB 1,663.02 bln due to decreased direct non-medical and indirect costs in the form of GDP growth and reduced payments of pensions and disability benefits.