Performance-based financing for improving HIV/AIDS service delivery: A systematic review

Amitabh B. Suthar, Jason M. Nagata, Sabin Nsanzimana, Till Bärnighausen, Eyerusalem K. Negussie, Meg Caroline Doherty

Research output: Contribution to journalArticle

Abstract

Background: Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines. Methods: PubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207. Results: Four studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported. Conclusions: Although the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.

Original languageEnglish (US)
Article number6
JournalBMC Health Services Research
Volume17
Issue number1
DOIs
StatePublished - Jan 4 2017
Externally publishedYes

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Acquired Immunodeficiency Syndrome
HIV
Confidence Intervals
Pregnant Women
Africa South of the Sahara
Health
Treatment Failure
PubMed
MEDLINE
Registries
Meta-Analysis
Motivation
Odds Ratio
Clinical Trials
Databases
Guidelines
Costs and Cost Analysis
Research

Keywords

  • Access
  • AIDS
  • Antiretroviral therapy
  • Efficiency
  • Health financing
  • HIV
  • HIV testing
  • HIV treatment
  • Quality
  • Service
  • Universal health coverage

ASJC Scopus subject areas

  • Health Policy

Cite this

Performance-based financing for improving HIV/AIDS service delivery : A systematic review. / Suthar, Amitabh B.; Nagata, Jason M.; Nsanzimana, Sabin; Bärnighausen, Till; Negussie, Eyerusalem K.; Doherty, Meg Caroline.

In: BMC Health Services Research, Vol. 17, No. 1, 6, 04.01.2017.

Research output: Contribution to journalArticle

Suthar, Amitabh B. ; Nagata, Jason M. ; Nsanzimana, Sabin ; Bärnighausen, Till ; Negussie, Eyerusalem K. ; Doherty, Meg Caroline. / Performance-based financing for improving HIV/AIDS service delivery : A systematic review. In: BMC Health Services Research. 2017 ; Vol. 17, No. 1.
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abstract = "Background: Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines. Methods: PubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207. Results: Four studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95{\%} confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95{\%} CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95{\%} CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95{\%} CI 1.50 to 1.59), infants (RR 1.92, 95{\%} CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95{\%} CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95{\%} CI 0.32 to 0.97). Potential harms were not reported. Conclusions: Although the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.",
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AU - Bärnighausen, Till

AU - Negussie, Eyerusalem K.

AU - Doherty, Meg Caroline

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