Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

TUADO203 TUADO205
The impact of antiretroviral therapy on employment Funding HIV prevention in developing countries:
outcomes of HIV-infected individuals and their equity vs. efficiency
families: evidence from rural western Kenya

H. Thirumurthy', J. Graff Zivin2, M.P. Goldstein3. 'Yale University, Department
of Economics, New Haven, United States, 2Mailman School of Public Health,
Columbia University, Department of Health Policy and Management, New
York, United States, 3The World Bank, Poverty Reduction Group, Washington,
DC, United States
Background: The well-documented health benefits of antiretroviral therapy
(ART) have the potential to dramatically improve socio-economic outcomes of
individuals and families affected by HIV/AIDS. Yet even as treatment programs
are scaled-up, there is little empirical evidence on the socio-economiC' impact
of ART in Africa. Using household survey data, this study offers the first
examination of how ART affects employment outcomes of patients and their
family members.
Methods: Socio-economic data were prospectively collected for all individuals
in the households of 191 adult patients receiving ART at an HIV clinic in western
Kenya between March 2004 and February 2005. Changes in two self-reported
employment outcomes were analyzed: participation in the labor force (including
self-employed agriculture) and number of hours worked in the past week.
Socio-economic data were also collected simultaneously from 503 households
chosen randomly from villages in the rural clinic's catchment area (population
6,643 households). These data were used to control for confounding factors
that influence employment, such as seasonality in agricultural and weather
patterns.
Results: Within six months after the initiation of treatment, patients' labor
force participation rates rose 12.3 percentage points (p=0.03) and weekly
hours worked rose 6.9 hours (p=0.09). Relative to pre-treatment employment
levels, weekly hours worked rose by 35 percent. Young boys (between 8-12
years) in patients' households worked significantly fewer hours after treatment
was initiated for the patient. There was no change in employment activities of
girls and other adults in patients' households.
Conclusions: ART resulted in a rapid increase in employment for patients and
reduced the need to work among boys living with patients. The reduction in
child labor due to ART could also result in improved nutritional and schooling
outcomes for children. The results demonstrate that ART provides significant
non-health benefits for individuals and households in resource-poor settings.
TUADO204
Negotiating antiretroviral drug prices to increase
access: challenges and opportunities
E.C. Seoane Vazquez', R. Rodriguez-Monguio2. 1'Ohio State University, College
of Pharmacy & School of Public Health, Columbus -OH, United States, 2Ohio
State University, School of Public Health, Columbus -OH, United States
Issues: This study analyzes the impact of the Andean Countries negotiation
(Lima 2003) of antiretroviral drug (ARVs) prices. The study objectives were:
to assess the problems faced by the Andean countries during the negotiation
process, to evaluate the impact of the negotiation on prices paid by public
programs, and to identify factors that made it difficult for countries to purchase
ARVs at the negotiated prices and standards.
Description: The Lima negotiation (2003) marked the first time generic
companies participated in a multinational negotiation. The objectives of the
negotiation were to reduce the cost of and expand access to HIV tests and ARVs.
The Pan American Health Organization - World Health Organization provided
technical support during the negotiation process. The information derived from
a bibliographic review and a survey of prices directed to the Andean countries
ministries of health. Prices paid by public programs were analyzed by program,
country and company. ARVs purchases were converted to common units and
U.S. dollars.
Lessons learned: The negotiation achieved lower prices and higher quality
standards. In general, public programs of the six countries analyzed did not
purchase ARVs from the companies that participated in the negotiation, nor
did they base purchases on the prices or quality and bioequivalence criteria
established in the negotiation. Prices paid by the Andean countries' public
programs in 2004 ranged from 84.7% to 4477.8% of the average negotiated
prices, with a weighted average of 165.4%.
Recommendations: Successful development and implementation of
multinational price negotiations require that participant countries coordinate
regulations and policies related to drug registration, quality and bioequivalence,
international trade, intellectual property, and procurement. At the national
level, more efficient use of resources could be achieved upon coordination of
each country's various health care programs; improvement of the countries'
epidemiological and information systems; and strengthening of the procurement
and distribution systems.

A. Lasry', G.S. Zaric2, M.W. Carter3. 'University of Toronto, Department of
Mechanical & Industrial Engineering, Montreal, Canada, 2University of Western
Ontario, Ivey School of Business, London, Canada, 3University of Toronto,
Department of Mechanical & Industrial Engineering, Toronto, Canada
Background: Funds spent on HIV prevention commonly traverse several levels
of distribution. Funds may be allocated to regions, and regional authorities
may then allocate their share to sub-regions or targeted risk groups. Decision
makers at each level often use equity approaches that may result in suboptimal
allocation of resources. We examine the impact of optimal versus equitybased allocation of HIV prevention funds when there are two levels of decision
making.
Methods: We consider two lower level regions, each divided into two subpopulations, high risk and low risk. Sub-populations are modeled as a fourcompartment epidemics model where the population is divided by disease state
and maturity. We consider two allocation approaches: optimization, which aims
to minimize the number of new infections; and equity, which allocates funds
proportionally to the number of HIV cases. The model is populated using data
from Kenya and Botswana.
Results: In the baseline scenario, the gap between the best solution approach
(optimization at both levels) and the worst solution approach (equity at both
levels), represents an 8% decrease in the number of new infections. But, 85%
of the gap lies between the equity at the lower level and optimization at the
upper level approach, and the optimization at the lower level and equity at the
upper level approach. In 200 scenarios evaluated, when optimization is applied
to one level, there are fewer new infections if it is applied at the lower level
than the upper level.
Conclusions: HIV resource allocation approaches strongly influence epidemic
outcomes and serious consideration should be given to optimizing the lower
levels of decision-making. The importance of the HIV allocation approaches
increases when resources are more constrained. Decision-makers should not
focus solely on higher level allocations; this can yield ineffective use of scarce
resources.
Track E
TUAEOIO1
Nothing about us without us: greater, meaningful
involvement of drug users in the response to
HIV/AIDS
R. J0rgens', R. Elliott2, J. Csete2, D. Palmer3, A. Livingston4, G. Liang4,
T. Kerrs. 'Canadian HIV/AIDS Legal Network, Mille-Isles, Canada, 2Canadian
HIV/AIDS Legal Network, Toronto, Canada, 3CACTUS, Montreal, Canada,
4Vancouver Area Network of Drug Users, Vancouver, Canada, 5BC Centre for
Excellence in HIV/AIDS, Vancouver, Canada
Issues: In many countries, IDUs continue to be over-represented among
people who contract HIV and/or HCV.Yet meaningful involvement of IDUs in
the response to HIV and HCV and, more broadly, in decisions that affect their
health and lives, remains limited. In some countries, there has been growing
recognition of the need to involve IDUs, but even there little is done to ensure
effective and meaningful participation in practice.
Description:
(1) Form partnership between a research and advocacy organization working
on HIV/AIDS and human rights issues, drug user organizations, a universitybased research centre, and a needle exchange program.
(2) Undertake literature review and extensive consultations with drug users,
service providers, and policy makers.
(3) Produce and widely disseminate a comprehensive paper and an accessible
booklet summarizing the paper's main points addressing:
(a) what is meant by greater involvement of IDUs;
(b) arguments and research on benefits of involvement;
(c) challenges to involvement and ways to overcome them.
(4) Develop and disseminate a drug user manifesto.
Lessons learned: There are ethical and human rights arguments for
involvement of IDUs. In addition, research has provided evidence of the benefits
of involvement. IDUs have demonstrated that they can organize themselves
and make valuable contributions to their community, expand the reach and
effectiveness of HIV prevention and harm reduction services, provide muchneeded care and support, and advocate for their rights and the recognition of
their dignity.
Recommendations: It is time to move from commitment to greater
involvement in principle to ensuring involvement in practice. The project makes
a series of concrete recommendations aimed at ensuring greater, meaningful,
and sustained involvement, including: explicit recognition by governments of
the value of such involvement; funding for drug user organizations; and creating
the conditions under which users can effectively participate in consultative
processes, decision-making or policy-making bodies and advisory structures.

Tuesday
15 August
Graf
Abstract
Sessic ns

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1