1. Morris Edwards Nadia Liu
Sustaining the AIDS response in Guyana: Optimizing available resources for maximal impact.
Morris Edwards
Nadia Liu

2. Country profile Size: 216,000 Km2 Population 747,884 (2012)
Population density: 3.6/km2
World Bank classification: Upper middle income (GDP/per capita 4,008)
HIV prevalence
Adult: 3.5% (2003); 1.6% (2017)
Youths 15-24: 0.9% F, 0.6% M (2014)
FSW: 5.5% (2014)
MSM: 4.9 (2014)
T.G: 8.4% (2014)
ART coverage: 58% (2017)
HIV cascade:
NSP : Reduce new HIV infections & death by 50%

3. Policy questions To determine
How close will Guyana get to the HIV NSP targets if the 2015 budget envelope is annually available a) allocated according to current investment patterns b) optimally allocated across different programs and geographical regions?
What additional investment is required to achieve the NSP targets, if funds are optimally allocated?
What would be the optimal allocation of the HIV budget if more or less resources were available?
What epidemiological effects could be expected if there were no further investments from the Government of Guyana in the HIV response?
What are the costs and impacts of (i) achieving and (ii) implementing treat-all by 2018, assuming that funding to prevention programs is allocated as it was in 2015?
If management and other ‘indirect’ costs can be cut by 20%, and this would not adversely affect the implementation of direct programs, how should these funds be optimally reallocated, and what would the impact of this be?

4. Methodology
Allocative efficiency programme effectiveness study (AEPE) of govt and donor spending in 2015
Numerous data sources
Guyana Bio-behavioural survey 2014; UN Pop Division; Spectrum; GARPR; UNAIDS AIDS info database; Statistical Dept. MOPH Guyana; PEPFAR; GFATM
Modelling using Optima-HIV software
Formal mathematical optimization algorithm to calculate optimal allocation of HIV investments across 10 regions and 7 core programmes
Estimates validated against those of Spectrum

5. Results: HIV investments
HIV expenditure in Guyana by source (2015)
Year
Investments
2011
17 M
2012
27 M
2015
9.9 M
PEPFAR funding to Guyana ( )

6. Funding by programmatic area
Programme area
GoG (US$)
USG (US$)
GFATM (US$)
Total US$ (%)
Gen. pop prevention -
211,996
211,996 (2.13)
Other prevention
137,954
245,752
383,706 (3.86)
FSW
12,457
191,397
19,222
223,076 (2.24)
MSM
28,476
108,727
156,425 (1.57)
HTC
195,795
456,460
78,850
731,105 (7.36)
ART
-466,848
954,478
291,956
1,713,282 (17.24)
lab
736,297
238,616
974,913 (9.81)
PMTCT
295,419
110,337
405,756 (4.08)
Other care
142,681
508,414
118,858
769,953 (7.75)
Management
127,524
2,757,326
2,884,850 (29.03)
OVC
149,665
149,665 (1.51)
M&E
32,190
216,779
248,969 (2.51)
Human Resource
256,890
125,928
382,818 (3.85)
Enabling environment
184,087
184,087 (1.85)
Infrastructure
4,762
389,519
394,281 (3.96)
Research
121,951
121,951 (1.23)
Total
2,437,293
6,759,436
740,104
9,936,833 (100)

7. A comparison of the current allocation of funds with the optimal allocation for achieving the targets of the NSP at minimal cost

8. New HIV infections in Guyana (2012, 2016, 2020) assuming no investments by the Government of Guyana

9. Annual treatment needs, new HIV infections, HIV-related deaths and HIV-related DALYs under current conditions compared with the achievement of in Guyana

10. HIV infections (left) and HIV-related deaths (right) under current conditions compared with scenario in which management costs are reduced and the funds are optimally allocated.

11. Conclusion
Current allocation of funds will not lead to achievement of the NSP goals.
Instead of a 50% reduction in new HIV infections, there would be a 12% increase in new HIV infections
Optimally allocating funds across programmes and regions of the country will result in a 37% reduction in new HIV infections
By ensuring a more efficient management programme, Guyana would free up funds to place more PLHIV on treatment
Reducing programme management costs by 20% would release an additional US$576,000
Optimally allocating these funds would avert an additional 51% of new infections and 42% of deaths.

12. Conclusion………
Optimally allocating resources can improve impact even with no additional funds with substantial reduction in new HIV infections and AIDS related deaths and can reduce costs.
Reallocating funds differently across programmes and geographical areas would enable Guyana to achieve its NSP targets
Guyana’s government should immediately seek to:
Reallocate and optimize its available resources
Explore avenues for new revenue generation to offset funding gaps from reduced donor support.